Version June 2024
| Device | Bilevel positive pressure device |
| Portable home ventilator | |
| Location | Chronic ventilator or step-down unit versus intensive care unit |
| Monitors | Trend pulse oximetry (SpO2) Heart rate Respiratory rate |
| Initial setup | Select/adjust nasal mask |
| Connect patient to bilevel positive pressure device (BPAP) in spontaneous mode | |
| Start IPAP = 6; EPAP = 2 cmH2O | |
| Supplemental oxygen at 0-3 LPM for SpO2 less than 89 percent | |
| Observe | Tolerance (log patient's complaints) |
| Dyspnea (Borg scale) | |
| Synchrony (rib cage/abdominal excursion with IPAP onset) | |
| SpO2 | |
| Vital signs | |
| Arterial blood gas in the morning | |
| Nasal mask titration | Increase IPAP by 2 cmH2O as tolerated up to a maximum of 20 cmH2O |
| Increase EPAP to 4 to 6 cmH2O as needed to improve SpO2 or decrease work of breathing in COPD patients | |
| FiO2 increased only after ventilation improved. Goal is to achieve SpO2 90 to 93 percent | |
| Switch to spontaneous/timed (S/T) mode at 12 breaths/min if indicated | |
| Face mask titration | Patients failing nasal mask will proceed to full face mask and above titration will be repeated |
| Patients failing full face mask and BPAP will proceed to volume ventilator (See Failure of nocturnal noninvasive ventilatory support below) | |
| Volume ventilator | Full face mask |
| Mode - assist control | |
| Flow - start 60 LPM | |
| Rate - set 2 to 4 bpm below patient spontaneous rate | |
| Volume - as tolerated but target minute ventilation >10 LPM | |
| FiO2 increased only after ventilation improved. Goal is to achieve SpO2 90 to 93 percent | |
| Failure of nocturnal noninvasive ventilatory support | Patient refuses to accept either the nasal or face mask (anytime during the trial) |
| Unacceptable deterioration in mental status (anytime) | |
| Intolerable dyspnea at any time or Borg scale >15 with no improvement | |
| Consider tracheostomy or other more acute treatment |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
