Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used

Size: px
Start display at page:

Download "Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used"

Transcription

1 Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used appropriately Can cause harm if used inappropriately

2 Main indication is the presence of tissue hypoxia Because of 1. Arterial hypoxaemia (inadequate oxygen content) 2. Failure of oxygen- haemoglobin transport system

3 Defined as oxygen saturation < 90% or arterial tension po2 < 60 mmhg Caused by Impaired gas exchange in the lung Alveolar hypoventilation Shunt that allows venous blood into the arterial circulation An arterial blood gas helps discriminate these possibilities

4 Occurs because of the failure of the Oxygen-haemoglobin transport system 1. Reduced oxygen carrying capacity in the blood e.g. anaemia, carbon monoxide poisoning 2. Reduced tissue perfusion e.g. shock

5 No evidence of benefit in acute coronary syndrome or stroke Some potential for harm Oxygen causes coronary vasoconstriction and reduces coronary blood flow Associated with reduced survival in minor and moderate stroke Not indicated in normoxic patients with drug overdoses or metabolic acidosis

6 Paco2 during oxygen administration as a function of Paco2 before oxygen treatment. Rodrigo G J et al. Chest 2003;124: by American College of Chest Physicians

7 Acute exacerbation of COPD is common May present with hypoxia May have chronic elevation of CO2 (>45mmHg) Natural tendency is to relieve hypoxia But oxygen can increase CO2 and reduce ph Acute ventilatory failure is notorious complication defined: hypercapnia and acidaemia

8 Chronic ventilatory failure Acute exacerbations of COPD Rare in stable COPD Obstructive sleep apnoea Obesity hypoventilation syndrome Neuromuscular disease, kyphoscoliosis?others Degree of hypoxia at presentation is better predictor than initial hypercapnia

9 Previous acute ventilatory failure on oxygen CO2 >45mmHg, ph <7.35 and O2 >70mmHg (spontaneous ventilation on supplemental inspired O2) Chronic ventilatory failure(any inspired O2) CO2 >45mmHg with COPD, OSA, Central Sleep Apnea, Obesity Hypoventilation Syndrome Previous acute ventilatory failure ph<7.35 and CO2 >45

10 History incomplete or unavailable Old clinical notes not available Arterial blood gases not feasible or available GCS reduced

11 Oxygen saturation should be monitored with pulse oximetry at least as frequently as other vital signs Clearly documented with inspired oxygen concentration

12 88-92% for all patients with or at risk or hypercapnic respiratory failure 94-98% for all other patients Special considerations for some poisons e.g. carbon monoxide, paraquat, bleomycin

13 Prevention of acute respiratory failure caused by excessive supplemental oxygen Minimise risk of acute ventilatory failure/respiratory acidosis Identify and manage acute ventilatory failure Identify population at risk Controlled oxygen therapy Reassess and titrate O2 to target saturation

14 PLUS any one of the following? Chronic lung disease e.g.: COPD (or suspected) Obesity (visual assessment) Home O 2 or CPAP/Bi-level PAP GCS <15 O 2 Alert- emr alert or Caution with O 2 card Neuromuscular disorder

15 obp < 100 mmhg systolic otrauma call osevere sepsis If any exclusion use another pathway Aim for O 2 saturation 94-98%

16 REDUCE oxygen to 28% o2l/min nasal prongs NP or oventuri mask VM 28%(yellow) If Target sat already achieved on room air or 2 L/min NP or VM <= 28% ocontinue current inspired O 2

17 Oxygen saturation (SpO 2 ) monitoring Venous Blood Gases (VBG) when initial bloods collected Caution with Oxygen stickers in observation + medication charts Drive nebulisers with Air (continue nasal O 2 )

18 On O 2 2 L/min, 28% If O 2 93% change to 1L/min via nasal prongs or 24% VM (blue) repeat step 3 on lower O2 If O % Target achieved Continue current FiO 2 until medical review IfO 2 < 88% Increase O 2 to target SpO2 Urgent Medical review Arterial Blood Gases (ABG) collection

19 On O 2 1 L/min, 24% If O 2 93% change to Remove oxygen (leave on room air) repeat step 3 on room air If O % Target achieved Continue current FiO 2 until medical review check VBG IfO 2 < 88% Increase O 2 to target SpO2 Urgent Medical review Arterial Blood Gases (ABG) collection

20 On room air If O 2 93% Continue on room air until medical review If O % Target achieved Continue on room air until medical review If O 2 < 88% Increase O 2 to target SpO2 Urgent Medical review Arterial Blood Gases (ABG) collection

21 Including any of: Acute breathlessness Decreasing conscious state Oxygen saturation < 88% and falling Oxygen requirements increasing

22 ph>7.35 and pco 2 <45mmHg Not acute ventilatory failure Reduce FiO 2 if possible ph<7.35 or pco 2 > 45mmHg Acute ventilatory failure possible Do ABG

23 CO 2 <45mmHg Not acute ventilatory failure Reduce FiO 2 if possible CO 2 > 45mmHg Acute ventilatory failure possible Check ABG ph and po2

24 po 2 >70 mmhg Reduce FiO 2 if possible po mmhg Target achieved Prescribe current FiO 2 po 2 < 55 mmhg Increase FiO 2 to target SpO2 Senior review Assess response with ABG

25 ph < 7.35 and CO2 > 45 Acute Respiratory Acidosis Consider NIV check GCS Senior review Assess response with ABG

26 Can be managed with Non-Invasive Ventilation (NIV) But increased LOS Morbidity ICU/HDU admissions Hospital resources May correct rapidly when inspired oxygen reduced

27 Doctor prescribe Maintain current inspired oxygen Target current range O 2 saturation Change Clinical Review criteria for SpO 2 to < 88% Document in ED flowchart and notes if CO 2 elevated or Acute Respiratory Acidosis Drive nebulisers with Air (continue nasal O 2)

28 Defined by: CO2 retention acidosis Complications: Narcosis Respiratory failure Death Outcomes: Mechanical ventilation Cardiac arrhythmia ICU admission Subsequent complications

29 Measure O 2 saturations If O 2 sats >92% no O 2 required If sats 85 to 92% 2 litres O 2 nasal prongs, monitor sats and measure ABGs If sats <85% high flow O 2 and titrate to keep sats >92% and measure ABGs [Beasley et al Thorax 2007]

30 No O 2 sats monitor available Suspect severe hypoxaemia Administer 2-3 litres O 2 nasal prongs [Beasley et al Thorax 2007]

31 High concentration oxygen therapy delays recognition of clinical deterioration Low concentration oxygen therapy allows deterioration to be detected earlier, and gives more time to intervene before life- threatening situation develops [Beasley et al Thorax 2007]

32 Flow rates, masks Venturi masks with known inspired O2 NIV with known inspired O2 CPAP Inspired O2 meters CO2 meters

33 Coloured wrist band Clear prescription for O2 in med records identifying acute resp acidosis risk with excessive O2 Warning label on medical record and med chart

34 CAUTION WITH OXYGEN! O2 ALERT TURN CARD OVER FOR INSTRUCTIONS I have Chronic Respiratory Disease My Carbon Dioxide can be raised Do NOT give me High Flow Oxygen! Low Flow Only < 28% Department of Respiratory Medicine Liverpool Hospital

35 Venturi mask 50% O2 back titrate SaO2 to 92% Caution with O2 ID and/or alert on EDIS/PASS Venturi 28% and SaO2 92% ABG s performed within 20 mins of starting supplemental O2

36 Patient receives 1. Caution With Oxygen ID card 2. Venturi O2 mask (28%) 3. Information leaflet 4. Instruction to give ID card and mask to Ambulance Officers or ED staff on presentation In addition Alert in emr Entry in Caution With Oxygen Register

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012.

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012. PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing

More information

Oxygen - update April 2009 OXG

Oxygen - update April 2009 OXG PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the

More information

Less is more in: Emergency Oxygen Therapy

Less is more in: Emergency Oxygen Therapy Less is more in: Emergency Oxygen Therapy Dr Ronan O Driscoll Consultant Respiratory Physician Salford Royal University Hospital Salford M6 8 HD ronan.o.driscoll@srft.nhs.uk Oxygen is the most commonly

More information

Respiratory failure and Oxygen Therapy

Respiratory failure and Oxygen Therapy Respiratory failure and Oxygen Therapy A patient with Hb 15 G % will carry 3X more O2 in his blood than someone with Hb 5G % Give Controlled O2 treatment in acute pulmonary oedema to avoid CO2 retention

More information

GUIDELINES FOR ACUTE OXYGEN THERAPY FOR WESTERN AUSTRALIAN HOSPITALS

GUIDELINES FOR ACUTE OXYGEN THERAPY FOR WESTERN AUSTRALIAN HOSPITALS GUIDELINES FOR ACUTE OXYGEN THERAPY FOR WESTERN AUSTRALIAN HOSPITALS Key Points 1. No patient should be denied oxygen therapy in an emergency. Patients in cardiac and/or respiratory arrest should be managed

More information

SIMPLY Oxygen Therapy. Dr William Dooley

SIMPLY Oxygen Therapy. Dr William Dooley SIMPLY Oxygen Therapy Dr William Dooley Plan Indications Delivery methods CPAP vs BiPAP Oxygen Devices Classified by Performance (variable or fixed) Duration (short term or long term) Flow (low or high)

More information

Acute Oxygen Therapy

Acute Oxygen Therapy Oxygen Therapy Acute Oxygen Therapy A life saving drug, very often given without careful evaluation of its potential benefits and side effects Like any drug there are clear indications for treatment with

More information

Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD

Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD This document describes the standard for clinical assessment, prescription, optimal management and follow-up of patients receiving domiciliary

More information

Oxygenation and Oxygen Therapy Michael Billow, D.O.

Oxygenation and Oxygen Therapy Michael Billow, D.O. Oxygenation and Oxygen Therapy Michael Billow, D.O. The delivery of oxygen to all body tissues is the essence of critical care. Patients in respiratory distress/failure come easily to mind as the ones

More information

Quantitative Gas Exchange Physiology. VQ Relationships

Quantitative Gas Exchange Physiology. VQ Relationships Quantitative Gas Exchange Physiology VQ Relationships Traditional Mechanisms of Hypoxemia: 1.Altitude 2.Shunt 3.VQ mismatching 4.Diffusion Impairment 5. Hypoventilation How does one explain worsened hypoxemia

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Pulmonary Diseases. Lung Disease: Pathophysiology, Medical and Exercise Programming. Overview of Pathophysiology

Pulmonary Diseases. Lung Disease: Pathophysiology, Medical and Exercise Programming. Overview of Pathophysiology Lung Disease: Pathophysiology, Medical and Exercise Programming Overview of Pathophysiology Ventilatory Impairments Increased airway resistance Reduced compliance Increased work of breathing Ventilatory

More information

Arterial Blood Gas Interpretation. Self-Learning Module

Arterial Blood Gas Interpretation. Self-Learning Module Arterial Blood Gas Interpretation Self-Learning Module Introduction Washington Hospital Center Nursing Education Department Arterial blood gas (ABG) results enable nurses to assess and monitor a patient

More information

Nye resultater med hjemme-niv. PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte)

Nye resultater med hjemme-niv. PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte) Nye resultater med hjemme-niv PD Dr. med. Thomas Köhnlein Respiratory Medicine (Head of Department: Prof. Dr. Tobias Welte) Physiologic targets of ventilation in COPD mechanical pressure support reduces

More information

Rule of thumb: PEEP reduced cardiac function when its normal, and improves it if increased preload is the problem.

Rule of thumb: PEEP reduced cardiac function when its normal, and improves it if increased preload is the problem. The Basics of Non-Invasive Mechanical Ventilation VENTILATOR SETTINGS TRIGGER - How sensitive the machine is to the patients attempts to breathe. Obviously, should be fairly sensitive. About -1 mmhg is

More information

Policy for the Prescription and Administration of Oxygen to Adults in Inpatient Facilities

Policy for the Prescription and Administration of Oxygen to Adults in Inpatient Facilities Policy for the Prescription and Administration of Oxygen to Adults in Inpatient Facilities August 2013 Page 1 of 32 Policy Title Policy for the Prescription and Administration of Oxygen to Adults in Inpatient

More information

GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY

GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY SOUTH DURHAM HEALTH CARE NHS TRUST GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY AIM To supplement oxygen intake using the appropriate equipment in order to correct hypoxia and relieve breathlessness.

More information

Non Invasive Ventilation (BiPAP)

Non Invasive Ventilation (BiPAP) Emergency Department Pathway Non Invasive Ventilation (BiPAP) Patient Name / Addressograph.. Address..... Date of birth. BiPAP is suitable for COPD patients with type 2 respiratory failure Note: If considering

More information

Non invasive Positive Pressure Ventilation (NPPV) for Acute Exacerbations of COPD: Evidence Base & How to Set up a Service.

Non invasive Positive Pressure Ventilation (NPPV) for Acute Exacerbations of COPD: Evidence Base & How to Set up a Service. Non invasive Positive Pressure Ventilation (NPPV) for Acute Exacerbations of COPD: Evidence Base & How to Set up a Service Dr Karen Detering Why use ventilatory assistance? patients with COPD are prone

More information

Adult Home Oxygen Therapy. Purpose To provide guidance on the requirements for and procedures relating to domiciliary oxygen therapy.

Adult Home Oxygen Therapy. Purpose To provide guidance on the requirements for and procedures relating to domiciliary oxygen therapy. Contents Purpose... 1 Scope/Audience... 1 Categories for Home Oxygen Therapy... 2 Assessment for Home Oxygen Therapy... 3 Investigations... 3 Requests for home oxygen... 3 Provision of Home Oxygen... 4

More information

By Dr. Nicole Spurlock, DACVECC

By Dr. Nicole Spurlock, DACVECC Hypoxia occurs in a variety of critical illnesses and results in inadequate delivery of oxygen to the tissues. Hypoxia occurs secondary to low oxygen levels in the plasma (hypoxemic hypoxia), low hematocrit

More information

Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease

Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease Q J Med 2005; 98:499 504 Advance Access publication 13 June 2005 doi:10.1093/qjmed/hci084 Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease H.J. DURRINGTON,

More information

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD)

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD) Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease Patient held record and self-management plan Keep this in a safe place and bring it with you to GP or hospital visits, including admissions.

More information

Peninsula Community Health. Policy for the Prescription, Administration. monitoring of Oxygen and Emergency Oxygen in Adults

Peninsula Community Health. Policy for the Prescription, Administration. monitoring of Oxygen and Emergency Oxygen in Adults Peninsula Community Health Policy for the Prescription, Administration and monitoring of Oxygen and Emergency Oxygen in Adults Title: Policy for the Prescription, Administration and monitoring of Emergency

More information

Arterial Blood Gas Case Questions and Answers

Arterial Blood Gas Case Questions and Answers Arterial Blood Gas Case Questions and Answers In the space that follows you will find a series of cases that include arterial blood gases. Each case is then followed by an explanation of the acid-base

More information

IEHP UM Subcommittee Approved Authorization Guidelines Home Use of Oxygen

IEHP UM Subcommittee Approved Authorization Guidelines Home Use of Oxygen Introduction: IEHP UM Subcommittee Approved Authorization Guidelines Home Use of Oxygen Home oxygen therapy provides oxygen at concentrations greater than the ambient air with the intention of treating

More information

Prescribing and Administration of Emergency Oxygen in Adults Policy

Prescribing and Administration of Emergency Oxygen in Adults Policy This is an official Northern Trust policy and should not be edited in any way Prescribing and Administration of Emergency Oxygen in Adults Policy Reference Number: NHSCT/12/542 Target audience: Medical,

More information

Using home NIV for the management of hypercapnic COPD

Using home NIV for the management of hypercapnic COPD Home NIV Program for COPD Using home NIV for the management of hypercapnic COPD This program offers COPD treatment guidelines to physicians to help appropriately target and qualify patients for noninvasive

More information

SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY

SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY PS1006 SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY TITLE: NON-INVASIVE POSITIVE PRESSURE (NPPV) VENTILATION (CPAP/BIPAP) Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: Director, Respiratory

More information

Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*

Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing* Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon

More information

Breathing at Ease. A Guide to Noninvasive Ventilation Therapy

Breathing at Ease. A Guide to Noninvasive Ventilation Therapy Breathing at Ease A Guide to Noninvasive Ventilation Therapy University of Michigan Medical Center Adult Assisted Ventilation Clinic Armando Kurili, BS, CRT Overcoming the Challenges of NIV Therapy Respiratory

More information

Course Objectives. NIV Definition. Noninvasive Ventilation in the Home

Course Objectives. NIV Definition. Noninvasive Ventilation in the Home Noninvasive Ventilation in the Home Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four

More information

CLINICAL COMPONENT FOR THE HOME OXYGEN SERVICE IN ENGLAND AND WALES

CLINICAL COMPONENT FOR THE HOME OXYGEN SERVICE IN ENGLAND AND WALES CLINICAL COMPONENT FOR THE HOME OXYGEN SERVICE IN ENGLAND AND WALES This document has been prepared by members of the British Thoracic Society (BTS) Working Group on Home Oxygen Services, which is a Sub-Committee

More information

Common Ventilator Management Issues

Common Ventilator Management Issues Common Ventilator Management Issues William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center You have just admitted a 28 year-old

More information

Alaska Native Medical Center. ANMC Guideline: Use of BiPAP Ventilation on Medical and Surgical Floors Outside the Critical Care Unit (CCU)

Alaska Native Medical Center. ANMC Guideline: Use of BiPAP Ventilation on Medical and Surgical Floors Outside the Critical Care Unit (CCU) Alaska Native Medical Center ANMC Guideline: Use of BiPAP Ventilation on Medical and Surgical Floors Outside the Critical Care Unit (CCU) 1. Purpose: To describe the conditions and procedure for applying

More information

Arterial Blood Gases, Digital Pulse Oximetry, and Routine Blood Work. By John R. Goodman BS RRT

Arterial Blood Gases, Digital Pulse Oximetry, and Routine Blood Work. By John R. Goodman BS RRT Arterial Blood Gases, Digital Pulse Oximetry, and Routine Blood Work By John R. Goodman BS RRT Patients with chronic lung disease frequently are tested to determine their lung function. The lungs basically

More information

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure.

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure. Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left

More information

Non Invasive Ventilation

Non Invasive Ventilation Non Invasive Ventilation Linda Grady Clinical Nurse Specialist 2010 Non-Invasive Ventilation (NIV) Technique that provides and enhances alveolar ventilation without the use of an endotracheal intubation

More information

Guideline for the prescription and administration of oxygen in children. Royal Hospital for Sick Children, Glasgow

Guideline for the prescription and administration of oxygen in children. Royal Hospital for Sick Children, Glasgow Guideline for the prescription and administration of oxygen in children. Royal Hospital for Sick Children, Glasgow Author: Dr Louise Thomson, Paediatric Respiratory Consultant Lynda Peacock, Complex Respiratory

More information

Plan of care for clients experiencing respiratory acidosis and alkalosis. values do we need to know????

Plan of care for clients experiencing respiratory acidosis and alkalosis. values do we need to know???? 1 Understanding ABG s Plan of care for clients experiencing respiratory acidosis and alkalosis 2 First the Basics.. An ACID is a substance which can donate a hydrogen ion or freely dissociate a hydrogen

More information

Understanding Hypoventilation and Its Treatment by Susan Agrawal

Understanding Hypoventilation and Its Treatment by Susan Agrawal www.complexchild.com Understanding Hypoventilation and Its Treatment by Susan Agrawal Most of us have a general understanding of what the term hyperventilation means, since hyperventilation, also called

More information

BIPAP Coverage Guidelines

BIPAP Coverage Guidelines BIPAP Coverage Guidelines BIPAP/E0470 DX: Thoracic Disorder There is documentation in the patient's medical record of a neuromuscular disease (for example, amyotrophic lateral sclerosis) or a severe thoracic

More information

Titration protocol reference guide

Titration protocol reference guide Titration protocol reference guide Description Page Titration protocol goals 4 CPAP protocol CPAP protocol 6 CPAP titration protocol 7 CPAP reimbursement criteria 8 BiPAP S protocol BiPAP S protocol 10

More information

Pathophysiology of hypercapnic and hypoxic respiratory failure and V/Q relationships. Dr.Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh

Pathophysiology of hypercapnic and hypoxic respiratory failure and V/Q relationships. Dr.Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh Pathophysiology of hypercapnic and hypoxic respiratory failure and V/Q relationships Dr.Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh Jan 2006 Respiratory Failure inadequate blood oxygenation

More information

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting

More information

DEFINITION OF TERMS CPAP

DEFINITION OF TERMS CPAP Title: BiPAP/CPAP Protocol BiPAP/CPAP Protocol EFFECTIVE DATE: APPROVED: POLICY The MD, or the RCP (pursuant to the MD s medical order for respiratory therapy to follow the BiPAP/CPAP protocol), shall

More information

Ventilation Perfusion Relationships

Ventilation Perfusion Relationships Ventilation Perfusion Relationships VENTILATION PERFUSION RATIO Ideally, each alveolus in the lungs would receive the same amount of ventilation and pulmonary capillary blood flow (perfusion). In reality,

More information

BTS sleep Course. Module 13 Introduction to elective use of non-invasive ventilation (prepared by J Stradling)

BTS sleep Course. Module 13 Introduction to elective use of non-invasive ventilation (prepared by J Stradling) BTS sleep Course Module 13 Introduction to elective use of non-invasive ventilation (prepared by J Stradling) What is NIV Uses of NIV Theoretical aspects Available technology Interfaces Specific uses Patient

More information

Titration Guidelines for CPAP, Bilevel, servo ventilation and AVAPS. 1.5 AARC and AAST CEU credits

Titration Guidelines for CPAP, Bilevel, servo ventilation and AVAPS. 1.5 AARC and AAST CEU credits Titration Guidelines for CPAP, Bilevel, servo ventilation and AVAPS. 1.5 AARC and AAST CEU credits Learning objectives List the titration goals for OSA management Understand the suggested protocols for

More information

AT HOME DR. D. K. PILLAI MUG @ UOM

AT HOME DR. D. K. PILLAI MUG @ UOM NON - INVASIVE VENTILATION AT HOME DR. D. K. PILLAI 07.09.2011 MUG @ UOM In the beginning came. OSA (HS) 1. CPAP for OSAHS (Obstructive Sleep Apnoea Hypopnoea Syndrome) 2 NIPPV 2. NIPPV (Non

More information

BTS Sleep Course. Module 10 Therapies I: Mechanical Intervention Devices. (Prepared by Debby Nicoll and Debbie Smith)

BTS Sleep Course. Module 10 Therapies I: Mechanical Intervention Devices. (Prepared by Debby Nicoll and Debbie Smith) BTS Sleep Course Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith) S7: Patient monitoring and review Aims Where problems can occur Clinic review protocol

More information

NHS FORTH VALLEY BIPAP Guideline

NHS FORTH VALLEY BIPAP Guideline NHS FORTH VALLEY BIPAP Guideline Date of First Issue 27 / 10 / 2010 Approved 27 / 10 / 2010 Current Issue Date 27 / 10 / 2010 Review Date 27 / 10 / 2012 Version Version 1.00 EQIA Yes 27 / 10 / 2010 Author

More information

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out

More information

Patients presenting with acute respiratory failure

Patients presenting with acute respiratory failure Use of a Ventilatory Support System (BiPAP) for Acute Respiratory Failure in the Emergency Department* Janet M. Poponick, MD; Jeffrey P. Renston, MD, FCCP; Richard P. Bennett, BS, RRT; and Charles L. Emerman,

More information

Clinical Guidelines Assessment Panel (CGAP) If approved by committee or Governance Lead Chair s Action; tick here

Clinical Guidelines Assessment Panel (CGAP) If approved by committee or Governance Lead Chair s Action; tick here A Clinical Guideline For Use in: By: For: Trust Guideline-Non Invasive Ventilation (NIV) Division responsible for document: Key words: Name and job title of document author s: Name of document author s

More information

EMERGENCY MEDICINE. Oxygen Therapy. CP Singh*, Nachhattar Singh**, Jagraj Singh***, Gurmeet Kaur Brar****, Gagandeep Singh****

EMERGENCY MEDICINE. Oxygen Therapy. CP Singh*, Nachhattar Singh**, Jagraj Singh***, Gurmeet Kaur Brar****, Gagandeep Singh**** EMERGENCY MEDICINE Oxygen Therapy CP Singh*, Nachhattar Singh**, Jagraj Singh***, Gurmeet Kaur Brar****, Gagandeep Singh**** Abstract The primary goal of oxygen therapy is to correct alveolar and/or tissue

More information

Homeostasis. The body must maintain a delicate balance of acids and bases.

Homeostasis. The body must maintain a delicate balance of acids and bases. Homeostasis The body must maintain a delicate balance of acids and bases. Metabolic and respiratory processes must work together to keep hydrogen ion (H+) levels normal and stable. ph of Blood The ph of

More information

BiPAP/NIV definitions

BiPAP/NIV definitions BiPAP/NIV definitions Bi-level Positive Airway Pressure is a type of non-invasive ventilation to provide positive pressure ventilation supporting patient s spontaneous breathing. A higher pressure (IPAP)

More information

Critical Care Resident Respiratory Education Series. Respiratory Care Department Alfred I. dupont Hospital for Children Wilmington, DE.

Critical Care Resident Respiratory Education Series. Respiratory Care Department Alfred I. dupont Hospital for Children Wilmington, DE. Critical Care Resident Respiratory Education Series Respiratory Care Department Alfred I. dupont Hospital for Children Wilmington, DE. Objectives: Oscillator a. Theory of operation b. Care of the patient

More information

How to use Ventilation, Bipap and Bag Valve Mask in the Emergency Department (and how to stop your patients Sats plummeting when you do RSI!

How to use Ventilation, Bipap and Bag Valve Mask in the Emergency Department (and how to stop your patients Sats plummeting when you do RSI! How to use Ventilation, Bipap and Bag Valve Mask in the Emergency Department (and how to stop your patients Sats plummeting when you do RSI!) How to use this package and a list of learning resources. So,

More information

MECHANISM OF ACTION INDICATIONS

MECHANISM OF ACTION INDICATIONS NONINVASIVE VENTILATION Noninvasive ventilation was commonly used in the 1950 s during the polio epidemic, mainly with negative pressure ventilators such as the iron lung. Noninvasive ventilation has recently

More information

Respiratory Distress. National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University

Respiratory Distress. National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University Respiratory Distress National Pediatric Nighttime Curriculum Written by Liane Campbell, MD Lucile Packard Children s Hospital, Stanford University Learning Objectives Review the initial assessment of patient

More information

From AARC Protocol Committee; Subcommittee Adult Critical Care Version 1.0a (Sept., 2003), Subcommittee Chair, Susan P. Pilbeam

From AARC Protocol Committee; Subcommittee Adult Critical Care Version 1.0a (Sept., 2003), Subcommittee Chair, Susan P. Pilbeam AARC - ADULT MECHANICAL VENTILATOR PROTOCOLS 1. Guidelines for Using Ventilator Protocols 2. Definition of Modes and Suggestions for Use of Modes 3. Adult Respiratory Ventilator Protocol - Guidelines for

More information

Importance of Protocols in the Decision to Use Noninvasive Ventilation

Importance of Protocols in the Decision to Use Noninvasive Ventilation Importance of Protocols in the Decision to Use Noninvasive Ventilation Janice L. Zimmerman, M.D. Weill Cornell Medical College The Methodist Hospital Houston, Texas Objectives Review application of protocols

More information

OXYGEN THERAPY. Pulmonary System The pulmonary system is responsible for external and internal respiration.

OXYGEN THERAPY. Pulmonary System The pulmonary system is responsible for external and internal respiration. WHY DOES THE BODY NEED OXYGEN? Every function in the body requires oxygen. Oxygen is needed to complete the metabolism of glucose to produce ATP which provides energy. If inadequate amounts of oxygen reach

More information

CLINICAL USE OF PULSE OXIMETRY

CLINICAL USE OF PULSE OXIMETRY CLINICAL USE OF PULSE OXIMETRY POCKET REFERENCE 2010 INTERNATIONAL Helping the World Breathe Free TM GLOBAL PRIMARY CARE AND PATIENT EDUCATION THE PURPOSE OF THIS GUIDE Chronic respiratory diseases such

More information

Patient Instructions for Home Medical Equipment

Patient Instructions for Home Medical Equipment Patient Name: ABC Patient ID #: Patient Instructions for Home Medical Equipment In order for ABC Health Care to complete the request for your prescribed home medical equipment, we will need the following

More information

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the

More information

FA 519 : Oxygen Administration for First Aid

FA 519 : Oxygen Administration for First Aid FA 519 : Oxygen Administration for First Aid TFQO: Wei-Tien Chang COI #301 EVREV 1: Michael Nemeth COI # EVREV 2: Chih-Hung Wang COI # Taskforce: First Aid COI Disclosure (specific to this systematic review)

More information

The arterial blood gas gives you information about two key areas of the patient s physiology: Gas exchange Acid-base balance

The arterial blood gas gives you information about two key areas of the patient s physiology: Gas exchange Acid-base balance Arterial blood gas (ABG) interpretation tutorial Introduction The arterial blood gas gives you information about two key areas of the patient s physiology: Gas exchange Acidbase balance Information about

More information

Introduction to Cardiopulmonary Exercise Testing

Introduction to Cardiopulmonary Exercise Testing Introduction to Cardiopulmonary Exercise Testing 2 nd Edition Andrew M. Luks, MD Robb Glenny, MD H. Thomas Robertson, MD Division of Pulmonary and Critical Care Medicine University of Washington Section

More information

Patient Care Policies & Procedures

Patient Care Policies & Procedures Page 1 of 6 Purpose To develop protocol guidelines for post-op treatment guidelines for Obstructive Sleep Apnea (OSA) patients and those who are at risk for OSA Basis for an OSA Protocol The basis for

More information

6 Easy Steps to ABG Analysis

6 Easy Steps to ABG Analysis 6 Easy Steps to ABG Analysis E-Booklet David W. Woodruff, MSN, RN- BC, CNS, CMSRN, CEN 571 Ledge Road, Macedonia, OH 44056 Telephone (800) 990-2629 Fax (800) 990-2585 1997-2012 Ed4Nurses, Inc. All rights

More information

ETCO2 Monitoring: Riding the Wave! Disclosure 4/11/2013

ETCO2 Monitoring: Riding the Wave! Disclosure 4/11/2013 ETCO2 Monitoring: Riding the Wave! Debbie Fox, MBA, RRT-NPS, FAARC Director, Respiratory Care Wesley Medical Center Disclosure I have no financial conflicts to disclose. I have participated in focus groups

More information

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation

More information

The Advantages of Transcutaneous Co 2 Over End-Tidal Co 2 for Sleep Studies PETCo 2 vs. TCPCo 2

The Advantages of Transcutaneous Co 2 Over End-Tidal Co 2 for Sleep Studies PETCo 2 vs. TCPCo 2 The Advantages of Transcutaneous Co 2 Over End-Tidal Co 2 for Sleep Studies PETCo 2 vs. TCPCo 2 Ramalinga P. Reddy, M.D., MBA, FCCP Director, Children s Pulmonary & Sleep Center Mercy Children s Hospital

More information

THE EFFECTS OF ANAESTHESIA ON RESPIRATORY FUNCTION

THE EFFECTS OF ANAESTHESIA ON RESPIRATORY FUNCTION THE EFFECTS OF ANAESTHESIA ON RESPIRATORY FUNCTION ANAESTHESIA TUTORIAL OF THE WEEK 205 15 TH NOVEMBER 2010 Dr Rachel Davison, FRCA Dr Daniel Cottle, FRCA North West Deanery School of Anaesthesia Correspondence

More information

Sign up to receive ATOTW weekly -

Sign up to receive ATOTW weekly - NON-INVASIVE VENTILATION IN THE INTENSIVE CARE UNIT ANAESTHESIA TUTORIAL OF THE WEEK 40 28 th DECEMBER 2006 Richard Beringer Contact: rich@rberinger.wanadoo.co.uk Self assessment Case 1: A previously healthy

More information

Non-invasive Ventilation (NIV)

Non-invasive Ventilation (NIV) Non-invasive Ventilation (NIV) (Risk Associated: Misuse & overuse) Dr.Wagih Ouda ICU Consultant Coordinator HMG Al Qassim Hospital Kingdom of Saudi arabia Objectives Introduction. Goals of NIV. Advantages

More information

Information for Patients using Non Invasive Ventilation (NIV) The Gwent Sleep & Ventilation Centre Chest Clinic, St.

Information for Patients using Non Invasive Ventilation (NIV) The Gwent Sleep & Ventilation Centre Chest Clinic, St. Information for Patients using Non Invasive Ventilation (NIV) The Gwent Sleep & Ventilation Centre Chest Clinic, St. Woolos Hospital How does NIV work? People receiving NIV need to wear a cushioned mask

More information

Overview MND. Overview 10/10/2013. Why am I here? What is NIV? When and why to consider starting How to start Problems When to stop How to stop

Overview MND. Overview 10/10/2013. Why am I here? What is NIV? When and why to consider starting How to start Problems When to stop How to stop Dr Tracy Smith Respiratory Physician Campbelltown Hospital September 2013 MND Progressive neurodegenerative disorder May effect any part of neuromuscular system Aetiology unclear Incidence 1.5-2.7/100,000

More information

ANZCOR Guideline 11.6.1 Targeted Oxygen Therapy in Adult Advanced Life Support

ANZCOR Guideline 11.6.1 Targeted Oxygen Therapy in Adult Advanced Life Support ANZCOR Guideline 11.6.1 Targeted Oxygen Therapy in Adult Advanced Life Support Summary This guideline provides advice on the administration of oxygen in the peri-arrest period. Who does this guideline

More information

NIV guide. This is made to simplify the initial settings in different clinical conditions. What to choose to perform NIV Contraindications for NIV

NIV guide. This is made to simplify the initial settings in different clinical conditions. What to choose to perform NIV Contraindications for NIV NIV guide This is made to simplify the initial settings in different clinical conditions What to choose to perform NIV Contraindications for NIV Predictors of failure of NIV What to Monitor during NIV

More information

Using Pulse Oximeters

Using Pulse Oximeters Using Pulse Oximeters Tutorial 1 the basics 1 World Health Organization, 2011. WHO, All rights 2011. reserved. The Pulse Oximeter In this tutorial you will learn about: The function of a pulse oximeter

More information

Management of acute exacerbations of COPD and Asthma similarities and differences

Management of acute exacerbations of COPD and Asthma similarities and differences Management of acute exacerbations of COPD and Asthma similarities and differences Importance Imp cause of morbidity and mortality Accelerated decline in lung function Poorer quality of life Increased medical

More information

IMPAIRED BLOOD-GAS EXCHANGE. Intraoperative blood gas analysis

IMPAIRED BLOOD-GAS EXCHANGE. Intraoperative blood gas analysis IMPAIRED BLOOD-GAS EXCHANGE Intraoperative blood gas analysis When do you perform BGA Intraoperatively? Informe actual NEVER Routine:Thoracic Thoracic, Cardiac,Neurosurgery Emergency situation Drop in

More information

Pediatric Airway Management

Pediatric Airway Management Pediatric Airway Management Dec 2003 Dr. Shapiro I., PICU Adult Chain of Survival EMS CPR ALS Early Defibrillation Pediatric Chain of Survival Prevention CPR EMS ALS Out-of-Hospital Cardiac Arrest SIDS

More information

Using the Pulse Oximeter

Using the Pulse Oximeter Using the Pulse Oximeter Tutorial 2 Advanced 1 World Health Organization, 2011. All rights reserved. Pulse oximetry advanced In this lesson you will learn about: Using an oximeter correctly What can interfere

More information

Arterial Blood Gas Interpretation

Arterial Blood Gas Interpretation Arterial Blood Gas Interpretation Lawrence Martin, MD, FACP, FCCP Associate Professor of Medicine Case Western Reserve University School of Medicine, Cleveland larry.martin@adelphia.net Information in

More information

THE MANAGEMENT OF PATIENTS REQUIRING BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) NON INVASIVE VENTILATION (NIV) IN CORK UNIVERSITY HOSPITAL GROUP

THE MANAGEMENT OF PATIENTS REQUIRING BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) NON INVASIVE VENTILATION (NIV) IN CORK UNIVERSITY HOSPITAL GROUP POLICY AND PROCEDURE ON THE MANAGEMENT OF PATIENTS REQUIRING BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) NON INVASIVE VENTILATION (NIV) IN CORK UNIVERSITY HOSPITAL GROUP Reference Number: PPG-CUH-CUH-62

More information

Function of Respiratory System. Respiratory Failure. Any condition in which the respiratory system fails to do its primary function:

Function of Respiratory System. Respiratory Failure. Any condition in which the respiratory system fails to do its primary function: Respiratory Failure Any condition in which the respiratory system fails to do its primary function: Oxygenate arterial blood and eliminate CO2 Function of Respiratory System Oxygenate arterial blood and

More information

High flow nasal cannula (HFNC) for respiratory support (Vapotherm Precision Flow)

High flow nasal cannula (HFNC) for respiratory support (Vapotherm Precision Flow) Neonatal Intensive Care Unit Clinical Guideline High flow nasal cannula (HFNC) for respiratory support (Vapotherm Precision Flow) Background: High flow nasal cannula (HFNC) refers to the delivery of humidified

More information

Pointing you in the right direction

Pointing you in the right direction Pointing you in the right direction Dr Bronwyn Avard Ms Heather McKay Ms Nicole Slater Dr Kathryn Daveson Dr Paul Lamberth Dr Tony Lafferty Ms Susan Chen Mr John Darvill Dr Imogen Mitchell COMPASS 2008

More information

Oxygen: Friend or Foe?

Oxygen: Friend or Foe? Oxygen: Friend or Foe? Brandan Kennedy, MD Pediatric Hospital Medicine, Childrens Mercy Hospital and Clinics Assistant Professor of Pediatrics University of Missouri, Kansas City Objectives Brief history

More information

The Basics of ASV. Tips to a Successful Titration. Susan Keller Yenney, RPSGT

The Basics of ASV. Tips to a Successful Titration. Susan Keller Yenney, RPSGT The Basics of ASV Tips to a Successful Titration Susan Keller Yenney, RPSGT The Basics of ASV - Objectives Understand ASV terminology Recognize parameters which need to be adjusted Differentiate between

More information

MECHINICAL VENTILATION S. Kache, MD

MECHINICAL VENTILATION S. Kache, MD MECHINICAL VENTILATION S. Kache, MD Spontaneous respiration vs. Mechanical ventilation Natural spontaneous ventilation occurs when the respiratory muscles, diaphragm and intercostal muscles pull on the

More information

Pulmonary Complications after General Anesthesia

Pulmonary Complications after General Anesthesia Pulmonary Complications after General Anesthesia Brent Hadder, M. D. Assistant Professor Division of Surgical Intensive Care Palliative Care Service I have no financial support to disclose. 1 Pulmonary

More information

MODULE. POSITIVE AIRWAY PRESSURE (PAP) Titrations

MODULE. POSITIVE AIRWAY PRESSURE (PAP) Titrations MODULE POSITIVE AIRWAY PRESSURE (PAP) Titrations POSITIVE AIRWAY PRESSURE (PAP) TITRATIONS OBJECTIVES At the end of this module the student must be able to: Identify the standards of practice for administering

More information

Early Supported Discharge and Admission Avoidance Service for Chronic Obstructive Pulmonary Disease (COPD)

Early Supported Discharge and Admission Avoidance Service for Chronic Obstructive Pulmonary Disease (COPD) Early Supported Discharge and Admission Avoidance Service for Chronic Obstructive Exceptional healthcare, personally delivered 2 What is early supported discharge and admission avoidance and why do we

More information

Management of exacerbations in chronic obstructive pulmonary disease in Primary Care

Management of exacerbations in chronic obstructive pulmonary disease in Primary Care Management of exacerbations in chronic obstructive pulmonary disease in Primary Care Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality.

More information