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Gold Cross Ambulance. CPAP. Continuous Positive Airway Pressure. Presentation Structure. Goal of CPAP in the field CPAP and its physiological effects CPAP delivery systems Medical applications of CPAP When not to use CPAP. Goal of CPAP. To have an effective way to treat CHF/COPD

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CPAP

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Gold Cross Ambulance

CPAP

Continuous

Positive

Airway

Pressure


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Presentation Structure

  • Goal of CPAP in the field

  • CPAP and its physiological effects

  • CPAP delivery systems

  • Medical applications of CPAP

  • When not to use CPAP


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Goal of CPAP

  • To have an effective way to treat CHF/COPD

    • Medications are continued throughout patient care


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History of CPAP

1912 - Maintenance of lung expansion during thoracic surgery (S. Brunnel)

1937 - High altitude flying to prevent hypoxemia. (Barach et al)

1967 - CPPB + IPPV to treat ARDS (Ashbaugh et al)

1971 - Term CPAP introduced, used to treat HMD in neonates (Gregory et al)

1972 - CPAP used to treat ARF (Civetta et al)

1973 - CPAP used to treat COPD (Barach et al)

1981 - Downs generator(Fried et al)

1982 - Modern definition of CPAP(Kielty et al)


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CPAP and Patient Airway Pressure

‘The application of positive airway pressure throughout the whole

respiratory cycle to spontaneously breathing patients.


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CPAP and Partial Pressure

‘The pressure of a gas mixture is equal to the sum of the partial pressures of its constituents.

This allows oxygen into the blood during inspiration and Carbon Dioxide out during expiration.

Example : Air at sea level has a pressure of 760mm Hg.

Air is 21% oxygen and 79% nitrogen.

 partial pressure of oxygen is 760 X 21% = 159mm Hg


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So why does oxygen pass into the blood?

Pressure Gradient

Deoxygenated blood has a lower partial pressure of oxygen than alveolar air so oxygen transfers from the air into the blood.


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CPAP alters the pressure gradient!

7.5cm H20 CPAP

1cm H2O is equal to 0.735mm Hg.

7.5cm H2O CPAP increases the partial pressure of the alveolar air by approximately 1%.

This increase in partial pressure ‘forces’ more oxygen into the blood.

Even this comparatively small change is enough to make a clinical difference.


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The Requirements Of CPAP

  • The real requirement is for Continuous CONSTANT Positive Airway Pressure

  • A stable airway pressure as prescribed in order to reduce work of breathing (WOB)


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CPAP is oxygen therapy in its most efficient form.

  • Simple Masks

  • Venturi Masks

  • Humidifiers

  • CPAP


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Important Aim Of CPAP Is To Increase Functional Residual Capacity (FRC)

  • Volume of gas remaining in lungs at end-expiration

  • CPAP distends alveoli preventing collapse on expiration

  • Greater surface area improves gas exchange


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Physiological Effects Of CPAP

  • Increases PSO2

  • Increases FRC

  • Reduces work of breathing


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Essential Components Of A CPAP System

1. Flow generator

2. CPAP valve


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Whisperflow Flow Generators


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Caradyne Isobaric CPAP Valve


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Patient Connections - Face Mask


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The High Flow System In Operation

Air Supply In

Total Flow 60 L/min


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Application of CPAP


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Application Continued


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CPAP System


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Gold Cross Ambulance

Current Uses of CPAP

1. Ambulance/Emergency Room

2. Pre-Operative (Anesthesia)

3. Intensive Care

4. Recovery Room

5. General Ward


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Clinical Applications of CPAP

ConditionArea for Treatment

ARDSEmergency

Pulmonary edemaEmergency

Acute Respiratory FailureEmergency

CHF/COPDEmergency

AnesthesiaPre Operative

AtelectasisICU/General Ward

Alternative to Mechanical VentilationICU/General Ward

Weaning from Mechanical VentilationICU/General Ward

Also:

Left Ventricular Failure

Renal Failure

Sleep Apnea


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Adult Respiratory Distress Syndrome (ARDS)

  • Characteristics

    Hypoxemia

    Reduced compliance

    Large intrapulmonary shunt

  • CPAP in early stages may

    Correct hypoxemia

    Improve compliance

    Reduce intrapulmonary shunt

    (Schmidt 1975)


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CPAP And Pulmonary Edema

  • Severe pulmonary edema is a frequent cause of respiratory failure

  • CPAP increases functional residual capacity

  • CPAP increases transpulmonary pressure

  • CPAP improves lung compliance

  • CPAP improves arterial blood oxygenation

  • CPAP redistributes extravascular lung water

    (Rasanen 1985)


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Redistribution Of Extravascular Lung Water With CPAP


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CPAP And Acute Respiratory Failure

  • CPAP overcomes inspiratory work imposed by auto-peep

  • CPAP prevents airway collapse during exhalation

  • CPAP improves arterial blood gas values

  • CPAP may avoid intubation and mechanical ventilation

    (Miro 1993)


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When Not To Use Mask CPAP

  • Hypercapnia

  • Pneumothorax

  • Hypovolemia

  • Severe facial injuries

  • Patients at risk of vomiting


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Common Complications With CPAP

  • Pressure sores

  • Gastric distension

  • Pulmonary barotrauma

  • Reduced cardiac output

  • Hypoventilation

  • Fluid retention


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CPAP Training Flow Sheet

  • No Exclusion Criteria Present

  • -Respiratory/Cardiac Arrest

  • Pt.unable to follow commands

  • Unable tp maintain patent airway independently

  • Major Trauma

  • Suspicion of a Pneumothorax

  • Vomiting or Active GI Bleed

  • Obvious signs/Symptoms of Pulmonary infection

  • 2 or more of the following Respiratory Distress

  • Inclusion Criteria

  • Retractions of accessory muscles

  • Brochospasm or Rales on Exam

  • Respiratory Rate > 25/min.

  • O2 Sat. < 92% on high flow O2

Administer CPAP using Max FIO2

Stable or Improving Reassess Patient Deteriorating

  • -Contact Medical Control with report

  • Discontinue CPAP unless advised by Medical Control

  • Continue Asthma/COPD/Pulmonary Edema Protocols

  • Continue CPAP

  • Continue COPD/Asthma/Pulmonary Edema Protocol

  • Contact Medical Control with a Report

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