RT 210 HyperinflationTX PPT
RT 210 Lung Expansion / Hyperinflation TX RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Indications To improve atelectasis To prevent atelectasis Post-op COPD Other pulmonary complications Mobilize secretions RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Contraindications Patient Patient Patient Patient unable to cooperate unable to follow instructions unconscious unable to take deep breaths RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Hazards Ineffective unless performed correctly Hyperventilation Barotrauma Discomfort secondary to pain Fatigue RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Procedure Slow deep inspiration Inspiratory hold Relaxed exhalation Volume of gas moved should be inspiratory capacity Maximum inhalation following a quiet exhalation RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Procedure (cont) Coaching the patient is important Encouragement Insure proper technique Frequency May be performed by patient after instruction Q 1 hour while awake Follow-up daily or PRN RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Equipment Most actually measure flow and time Triflow InspiRx Some measure volume Bartlett Edwards (Bellows) Inspiron (Vortex Principle) RT 210 Hyperinflation TX Sustained Maximal Inhalation/Incentive Spirometry – SMI/IS Patient Evaluation Alert Cooperative Physically able to increase IC greater than VT Should be 3 times predicted VT RT 210 Hyperinflation TX RT 210 Hyperinflation TX RT 210 Hyperinflation TX RT 210 Hyperinflation TX RT 210 Hyperinflation TX IPPB Intermitent Positive Pressure Breathing RT 210 Hyperinflation TX IPPB Indications Primary If patient has inadequate VC to facilitate a cough, VC less than 3 times predicted VT then VC less than 15ml/kg of ideal body weight RT 210 Hyperinflation TX IPPB Indications Secondary To deliver medication Improve I:E ratio Improve cough and mobilize secretions Alter V/Q To improve or prevent atelectasis To decrease CO2 temporarily RT 210 Hyperinflation TX Contraindications of IPPB Absolute An untreated closed pneumothorax RT 210 Hyperinflation TX Contraindications of IPPB Secondary Contraindications ICP > 15mmHg Hemodynamic instability Recent facial, oral, or skull surgery Tracheal-esophageal fistula Active hemoptysis Active TB Blebs or bullae RT 210 Hyperinflation TX Contraindications of IPPB Hazards/Complications Barotrauma - pneumothorax Nosocomial infection Hypocarbia Hyperoxia Tachypnea Gastric distension Impedance of venous return Air trapping RT 210 Hyperinflation TX Contraindications of IPPB Hazards/Complications (cont) Increased ICP O2 induced hypoventilation in COPD patients Decreased cardiac output May cause or worsen hemoptysis RT 210 Hyperinflation TX Contraindications of IPPB Hazards/Complications (cont) Hyperventilation Dizziness Loss of consciousness Tetany Paresthesia: Decreased cerebrovascular PCO2 during hyperventilation causes vasoconstriction and decreased cerebral blood flow RT 210 Hyperinflation TX Physiologic Effects of IPPB Increased intrapulmonary pressure Decreased venous return, worsened by increasing inspiratory time May decrease cardiac output Mechanical bronchodilation Altered I:E ratio RT 210 Hyperinflation TX Physiologic Effects of IPPB Altered V/Q ratio Mobilization of secretions Generally increased PaO2 and decreased PaCO2 Decreased work of breathing RT 210 Hyperinflation TX Administration of IPPB Demonstrate set-up Check for leaks Patient instruction Passive treatment Slow deep inspiration with hold Maintain seal Explain nature of and expected results of Rx Rx should be gentle start to inhalation, with slow, deep breath, followed by passive exhalation RT 210 Hyperinflation TX Administration of IPPB Coaching patient Calm and reassure patient/relaxation Verbally instruct in timing of inspiration and expiration Total relaxed exhalation RT 210 Hyperinflation TX Administration of IPPB Monitoring patient Breath sounds VT (3 times predicted VT) Respiratory rate Pulse: Stop Rx when increased by 20 BPM Verbal response Ask subjective responses Dizziness Tingling RT 210 Hyperinflation TX PAP Define & Physiologic Principles Indications Contraindications Hazards & complications of CPAP (Egan mini clinic) Equipment Administer Intermittent CPAP Monitoring and Troubleshooting RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Classification Positive pressure ventilator forces air into lungs Pneumatically powered doesn't require electricity (gas powered) Pneumatically driven It's regulator is like a gauge regulators Pneumatically driven ceramic switch Single circuited: the same gas supply goes to the patient that powers the machine RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Modes Assist Assist Control The only mode used for IPPB Patient sets rate, then machine delivers rate Used for continuous ventilation If patient fails to set rate, machine will deliver preset rate Control: machine set rate and does not allow patient to alter preset pattern RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Pressure cycled Cycling is what ends inspiration When set pressure is reached, machine ends inspiration Other possibilities of cycling Flow Time Volume Flow limit - can be set RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Flow pattern Determined by 100% or air mix setting due to effects of back pressure on the Venturi gate 100% - square wave, flow remains constant in the face of back pressure - "flow generator" Air mix - decaying flow curve due to partial closure of Venturi gate Due to back pressure, flow decreases as pressure increases RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Pressure pattern Determined by flow pattern 100% source gas rectilinear Air mix parabolic RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Internal resistance How the flow curve is effected by back pressure Air mix – low flow pattern is much effected by back pressure RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Principles of Operation Magnetism versus gas pressure Two chambers of machine divided by a diaphragm Left side: same as atmospheric pressure Right side - same as system pressure RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) On inspiration, diaphragm is drawn to the right by decreased system pressure when patient initiates a breath As pressure builds up on pressure side, the diaphragm is pushed back to the left over-coming pressure of the magnetic pull of the switch plate A ceramic switch is moved by diaphragm which turns gas flow on and off RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Specifications Flow is variable and adjustable Peak flows on 100% 0-50 LPM Peak flow on air mix 0-80 LPM Venturi gate Open -2 cm H2O Closes at 2cms H2O lower (Venturi gate spring resistance) then peak or set pressure RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Air Mix controller Determines 100% source gas or air mix Air mix If O2 is the source gas, FIO2 will be 0.4 to 0.8 The machine functions as a pressure generator 100% FIO2 will be FIO2 of source gas The machine functions as a flow generator RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Nebulizer drive Nonadjustable FIO2 will be FIO2 of source gas Breaks off gas flow before Venturi Pressure Located on right side of ventilator Adjustable 0-60 cmH2O (Mark-7, 8, 10) In mmHg Mark-14 The closer the magnet to the clutch plate the higher the pressure required to cycle RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Sensitivity Adjustable on ambient (left) side of machine The closer the clutch plate to the magnet, the less sensitive or more pressure required to initiate inspiration Apnea Timer Works off of a small leak altering pressure internally Allows machine to be used for A/C or control modes Not used for routine IPPB RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Bird Mark 8 Has negative expiratory pressure capabilities Used Q circuit set-up Not normally used for IPPB RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Bird Mark 10 Has flow accelerator Increases flow at end inspiration to compensate for leaks RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Bird Mark 14 Has higher pressure capabilities, flow accelerator No negative pressure RT 210 Hyperinflation TX Bird Mark 7 & 8 (10 & 14) Circuit Large bore tubing Side stream or mainstream Exhalation valve One small bore tubing with "Y" to allow delivery to exhalation valve and nebulizer Mouthpiece, mask or trachea adaptor RT 210 Hyperinflation TX Bennett Ventilators Classification Positive pressure Pneumatically powered AP series is electrical Pneumatically driven Bennett Valve Single circuited Modes Assist: only for IPPB Assist/Control: not for IPPB treatments RT 210 Hyperinflation TX Bennett Ventilators Classification Flow cycled Pressure causes flow to drop to 1-3 LPM and ends inspiration PR-2 can be time cycled Pressure limited: Preset control pressure Decaying flow pattern Parabolic pressure pattern Low internal resistance: back pressure greatly influences flow pattern RT 210 Hyperinflation TX Bennett Ventilators Classification Method of Operation Bennett valve - a counter balanced drum with vanes and windows allowing rotation to permit flow through the windows or to stop it Sensitivity Adjustment to regulate patient effort Set as sensitive as possible to insure minimal patient effort Less than -2cm H2O for assist mode Nebulization Is off air dilution May be continuous or intermittent Adjustable RT 210 Hyperinflation TX Bennett Ventilators Classification Method of Operation Circuit setup Large bore tubing Nebulizer Adaptor to patient Expiratory valve 2 small bore tubes - one for expiratory valve and other for nebulization RT 210 Hyperinflation TX Description of Bennett Models AP-4 & 5 Electrically powered Compressor driven Flow sensitive Flow cycled (1-2 LPM) Single circuit Assistor only Pressure limited Low internal resistance Decaying flow pattern Parabolic pressure pattern RT 210 Hyperinflation TX Description of Bennett Models Venturi models - PR-1, PR-2 Knob in - room air entrained Knob out - 100% source gas Flow/Pres. characteristics same for both setting Air mix delivers FIO2 above 0.40 RT 210 Hyperinflation TX Description of Bennett Models PR-1 No Adjustment of peak flow No negative pressure No terminal flow (like flow accelerator on Bird) to compensate for leaks RT 210 Hyperinflation TX Description of Bennett Models PR-2 Has terminal flow Peak flow decelerator Negative pressure RT 210 Hyperinflation TX Description of Bennett Models AP Series Same Bennett valve Electrically compressor driven Used for home care frequently RT 210 Hyperinflation TX General Considerations For IPPB Therapeutic Units Increasing pressure will increase volume delivered and I:E ratio Increasing flow rate will decrease inspiratory time and decrease I:E ratio Increasing sensitivity is desirable unless autocycle occurs Rate control is not used during IPPB (pure assist mode) RT 210 Hyperinflation TX General Considerations For IPPB Therapeutic Units Nebulizer should be adjusted to create optimum aerosol production without wasting medication Initial volume/pressure relationship is based upon normal compliance value, and adjusted according to patient response and therapeutic goals RT 210 Hyperinflation TX
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