1. CPAP

2. Terminology NIV: Non-invasive ventilation
CPAP: Continuous positive airway pressure
BPAP: Bilevel positive airway pressure
BiPAP is brand name of BPAP

3. How it Works
Increases pressure in the lungs and holds open collapsed alveoli and narrowed bronchioles
Our patients with emphysema do this  pursued lip breathing.
Can help push the fluid from CHF out of the alveoli back into the capillaries
Can help get air past mucous plugs
Can help push more oxygen across the alveolar membrane
Reduces work of breathing

4. Side effects
Also increases intrathoracic pressure which will lower blood pressure
A plus if patient is hypertensive
A negative if patient is not hypertensive
Can be very claustrophobic
Can force some air into the stomach
Watch for vomiting

5. Conditions help by CPAP
Must be a spontaneously breathing patient
Moderate to severe respiratory distress from:
Congestive heart failure/pulmonary edema
COPD
Asthma
Pneumonia
Submersion injury
Undifferentiated respiratory distress
Also used for sleep apnea

6. VT Requirements District 11, use it when we think clinically necessary
VT protocol indications implies all these must be present:
Oxygen saturation <94%
Respiratory rate > 25
Retractions or accessory muscle use
District 11, use it when we think clinically necessary

7. contraindications Cardiac or respiratory arrest/apnea
Unable to follow commands
Unable to maintain their own airways
Agitated or combative behavior and unable to tolerate mask
Vomiting and/or active GI bleed
Respiratory distress secondary to trauma, why?
Suspicion of pneumothorax, why?
Facial trauma or impossible to seal face
Hypotension with SBP< 100 mmHg

8. procedure Ensure adequate O2 supply for CPAP device
Explain procedure to patient – be prepared to coach for claustrophobia
Place patient in upright position – apply pulse oximetry, capnography with nasal capture device
Choose appropriate sized mask, assemble device, attach to O2 supply and insure O2 is flowing
Place mask over face and secure with straps until minimum air leak
Adjust pressure to 5-10 cm H2O – titrate for effect

9. 7. Recheck mask for leaks and readjust straps as needed 8
7. Recheck mask for leaks and readjust straps as needed 8. Reassure anxious patient 9. Monitor vital signs, pulse oximetry, quantitative wave form capnography, and patient symptoms/ status 10. If patient improves, maintain CPAP for duration of transport and notify receiving hospital so they can have BPAP/CPAP ready on arrival 11. If patient begins to deteriorate, remove CPAP and assist respirations with BVM

10. Monitoring/documentation
Document CPAP procedure
including time and provider.
Document serial pulse oximetry, serial capnography, respiratory rate and effort
Improving? If not why? Reconsider use?
Close monitoring for nausea/vomiting
Close vital sign monitoring
especially BP.
How often?
Why?

11. Complications Hypotension Anxiety/ Claustrophobia
Impaired communication
Vomiting
High risk for aspiration

12. Medics
- Consider anxiolytic, with medical control, to tolerate the CPAP

13. Sources VT EMS Protocols
niv-and-asthma/
niv/