Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ RESPIRATORY SUPPORT ++Table Graphic Jump LocationTABLE 3.6Supplemental oxygen delivery devicesView Table||Download (.pdf) TABLE 3.6 Supplemental oxygen delivery devices Device Flow FiO2 Advantages Disadvantages Nasal Cannula 1–6 LPM 25%–40% FiO2 increases by 4% for every additional 1 LPM Cheap Tolerable Common device Variable FiO2 delivery based on RR, Vt, mouth breathing Simple Face Mask 6–10 LPM Flows >5 LPM will prevent rebreathing 35%–50% Accessible Easy to use Common device Generates high FiO2 Not as well tolerated, especially with delirious or anxious patients Not precise FiO2 delivery: Depends on RR and mask fit Non-rebreather (NRB) 10–15 LPM Flows >15 LPM ensure reservoir bag is always inflated 80%–95% High FiO2 delivery Less tolerable for some patients Must have one valve open to ensure patient safety High-Flow Nasal Cannula (HFNC) 10–60 LPM 21%–100% High FiO2 delivery with close titration Washes out dead space, decreasing work of breathing and RR Some PEEP at high flow rates Variable FiO2 delivery based on RR, Vt, mouth breathing Less mobile device ++Table Graphic Jump LocationTABLE 3.7Noninvasive positive pressure ventilation (NIPPV)View Table||Download (.pdf) TABLE 3.7 Noninvasive positive pressure ventilation (NIPPV) Device Settings Indications Clinical Uses Contraindications Continuous positive airway pressure (CPAP) Airway pressure (constant throughout respiratory cycle) Hypoxemia Cardiogenic pulmonary edema* Hypoxemic respiratory failure Obstructive sleep apnea - Unable to protect airway (encephalopathy, aspiration, vomiting, excessive secretions, UGIB) - At risk of losing airway (recent facial trauma or surgery, evolving obstruction with anaphylaxis or angioedema) - NIPPV inappropriate to address the cause of respiratory failure (e.g., fixed upper airway obstruction) - Unable to tolerate mask or inconsistent with goals of care Bilevel positive airway pressure (BiPAP) Inspiratory pressure (IPAP) Expiratory pressure (EPAP = PEEP) Hypoxemia Hypercapnia Cardiogenic pulmonary edema* Hypoxemic respiratory failure COPD exacerbations with hypercapnia Obesity hypoventilation syndrome (OHS) At risk of hypoventilation after extubation (COPD, OSA, OHS) *Mechanisms by which positive pressure improves cardiogenic pulmonary edema: Increased intrathoracic pressures decreases preload Increased alveolar pressure reduces filtration out of vessel via Starling forces: Positive pressure increases interstitial pressure that opposes intravascular hydrostatic pressure PEEP reduces LV afterload by decreasing wall stress: Increased intrathoracic pressure reduces LV transmural pressure so that the LV does not have to overcome a negative pressure on the outside of the heart in order to contract inwards Decreased LV transmural pressure also decreases myocardial oxygen consumption +++ Intubation and mechanical ventilation ++ Purpose: - Relieve respiratory distress - Improve gas exchange for CO2 (hypercarbia) and O2 (hypoxemia) - Decrease work of breathing - Protect airway in cases of low GCS (<8), apnea, inability to clear secretions Indications: Typically try noninvasive forms of ventilation before progressing to invasive mechanical ventilation, except in the setting of altered mental status, cardiac arrest, or severe respiratory compromise with impending arrest. Following are other clinical ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth