Pulmonary issues BPAP vs Vent

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    Could someone let me know what parameters are considered when deciding to switch patient from BPAP to a ventilator? What does t-apnea indicate. Some paperwork says patient on 15 L/m of O2, some say 45-70 L/m...my O2 tank regulator at my ASC only goes to 15 L/m so am I reading these ICU numbers right? Hope to get some answers from someone who is familiar with critical care as I am a surgical nurse.
    Thank you!
    Connie Belculfine, RN, CLNC
    ceb4412@hotmail.com
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  4. 7 Comments so far...

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    Personally I have never seen an 02 tank here in the US that is greater than 15/lpm......45-70 lpm? I have never seen.

    To place the patient on a vent is usually that the patient is SOB, on 100% FIO2, remains hypoxic and is tiring out.....or is having long periods of apnea.

    T-apnea must be a local term I do not know what that is.
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    You can have 45-79 Lpm In a high flow nasal cannula which is different from bipap and a vent. You can also adjust the % of O2 with that as well. Not sure if that's what they are referring to.
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    Explain this to me....I am not sure I know what this is.....
    45-79 Lpm In a high flow nasal cannula
    What I know is the high flow nasal 02 that is set at specific (usually 1-8lpm for pedi tubing and 8-10 for adult tubing) lpm and has a "mixer" that mixes RA to achieve a specific FIO2.

    So you have 8lpm delivering an FIO2 of 80% not 80lpm.

    http://vimeo.com/35337042
    Last edit by Esme12 on Dec 21, '12
  8. 1
    The device can, in fact, go to upwards to 60lpm. Not as high as I originally thought but higher than 8-10 lpm. If you could only achieve 8-10 lpm why not just use a mask? The high- flow uses special tubing, humidification, and warming. It can also be titrated to up to 100% fio2.

    The High Flow Nasal Cannula in the Emergency Department - emergency medicine updates
    NRSKarenRN likes this.
  9. 0
    Quote from limaRN
    The device can, in fact, go to upwards to 60lpm. Not as high as I originally thought but higher than 8-10 lpm. If you could only achieve 8-10 lpm why not just use a mask? The high- flow uses special tubing, humidification, and warming. It can also be titrated to up to 100% fio2.
    I know what you are talking about. When you say High-Flow NC most people imagine the nc with larger tubing that can go up to 15LPM, which is actually a Low flow device because it can not meet the patients inspiratory demand . However, the device in which you are speaking is a "Opti-Flow", which is a more "advanced" NC that can go up to 60 LPM when mixed with compressed air, and is a high-flow device.
  10. 0
    Quote from limaRN
    The device can, in fact, go to upwards to 60lpm. Not as high as I originally thought but higher than 8-10 lpm. If you could only achieve 8-10 lpm why not just use a mask? The high- flow uses special tubing, humidification, and warming. It can also be titrated to up to 100% fio2.

    The High Flow Nasal Cannula in the Emergency Department - emergency medicine updates
    Well I'll be darned....learn something new everyday I have not worked on this with adults. Off to go learn. Thanks!!!!

    If you have any information....PM me. I'd LOVE to see it!!!!
  11. 2
    Quote from Connie Belculfine
    Could someone let me know what parameters are considered when deciding to switch patient from BPAP to a ventilator? What does t-apnea indicate. Some paperwork says patient on 15 L/m of O2, some say 45-70 L/m...my O2 tank regulator at my ASC only goes to 15 L/m so am I reading these ICU numbers right? ceb4412@hotmail.com
    You or your source info must be referring to a very old BiPAP machine. For the past 15 years, most hospital machines have been blended and not bleed in O2. The 45 - 70 L/M also sounds like the driving flow of an older machine since some can now achieve up to 200 l/m.

    The newer machines can also be transported and will connect to a 50 psi regulator on an O2 tank. Most of the grab and goes have these now.

    Rule of thumb at some hospitals have been anything over 50% must go to a closely monitor stepdown or ICU and not just regular tele. That is if they still have a strong respiratory drive and gag present to maintain their airway. If the patient is still maintaining their airway and is somewhat alert, it will depend upon the reason for the BiPAP. If it is something the physician is reasonably sure he or she can turn around quickly the patient may remain on BiPAP even at 100% oxygen.

    This is an article from a Canadian journal which outlines a wide variety of disease processes. If the patient is in the ICU and monitored, it will be more of a clinical judgement for each case rather than just a set point number. Also, every BiPAP machine is different. If your machine is still doing a bleed in for O2 then my confidence level for that machine is very low. With limited capabilities for your BiPAP, you will have very little choice but to intubate at 15 L. Any more than that in the older machines and you affect its ability to trigger.

    But, consult you RT department for their policy and an inservice on the machine.

    Edit:

    The HFNCs are fantastics but may not be appropriate for all. They can deliver a little "CPAP" due to the high flows but the FiO2 will be dependant upon the patient's minute volume and how much is entrained through the mouth. A BiPAP machine will give 2 levels of pressure, hence "BiPAP", with a delta P for inspiratory phase. The flow on the newer machines have blended gas to ensure a more accurate FiO2 with the demand valve for each inspiratory effort.
    Last edit by TraumaSurfer on Dec 21, '12
    NRSKarenRN and Esme12 like this.


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