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? firstname.lastname@example.org
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.
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.