CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP)

Indications:  Any patient complaining of shortness of breath for reasons other than pneumothorax AND:

• Is awake, oriented, and able to cooperate
• Has the ability to maintain an open airway (GCS greater than 10)
• Has a respiratory rate greater than 25 breaths per minute
• Has a systolic blood pressure above 90 mmHg
• Uses accessory muscles during respirations

Contraindications:

• Children under 13 years of age (unless prior Medical Direction authorization has been granted)
• Facial deformities or patient too small for mask to seal - If the mask doesn’t fit, CPAP cannot be used
• Agonal respirations or respiratory arrest
• Pneumothorax
• Tracheostomy
• Unconsciousness or Altered Mental Status

Precautions:  Exercise extreme caution when administering CPAP if the patient has:

• Impaired mental status (GCS 10 or less) and is not able to fully cooperate with the procedure
• Failed at past attempts at noninvasive ventilation
• Active vomiting, upper GI bleeding or a history of recent gastric surgery
• Complaints of nausea
• Inadequate respiratory effort
• Excessive secretions

Procedure:

1. Explain the procedure to the patient.  Place the patient on continuous pulse oximetry and waveform capnography.  Ensure adequate oxygen supply to ventilation device (100% when starting and until SpO2 is at least 94%).
2. Place the delivery device over the mouth and nose.  Secure the mask with provided straps or the other provided devices.
3. Use 5 cm H2O of PEEP.  Check for air leaks.  If the distress does not improve and the patient is tolerating CPAP, increase CPAP pressure to 10 cm H2O, if available.
4. Monitor and document the patient’s respiratory response to the treatment  Continue to coach the patient to keep the mask in place and readjust as neede.
5. If the patient’s respiratory status deteriorates, remove the device and provide BVM ventilation and/or an advanced airway (SGA or endotracheal intubation).

Removal Procedure:

• Remove CPAP therapy ONLY when the patient cannot tolerate the mask or experiences continued or worsening respiratory failure.
• Consider BVM ventilation and/or an advanced airway (SGA or endotracheal intubation), CPAP therapy must be removed.

Special Notes:

• Contact BioTel as soon as the decision is made to use CPAP, so that the receiving hospital can prepare for the patient.
• Upon hospital arrival, do NOT remove CPAP until hospital therapy is ready to be placed on patient.
• Most patients will improve within 5 to 10 minutes.  If there is no improvement within this time, consider assisted ventilation with a BVM.
• Monitor the patient for gastric distention.