- 0Feb 7, '13 by sleepy17Hello...
I'm a student with a clinical rotation in the MICU, and I was hoping to have an experience clarified.
I recently followed a patient who was on the BiPap with worsening ABG's throughout the day. This patient had a hx of liver cirrhosis. She was scoped for an upper GIB, which was positive, although they didn't band any varices.
The patient ended up being intubated, which was very traumatic and bloody to say the least. Some were saying that the pt should have never been on the bipap with a GIB in the first place. Is this because of a risk of aspiration, or because it made her throat more dry/bloody? Rationale would be appreciated.
- 0Feb 7, '13 by Nurse_, BSN, RNI don't see why NOT.
How old is this person? Why didn't they band the varices? Did they put an esophageal balloon?
Oxygenation is important which is why she was placed on Bipap (I assume) and later on intubated. The main thing about varices is to prevent it from rupturing, you do it by banding or cauterizing and IV vasopressors.
- 0Feb 7, '13 by all517I could see rationale behind avoiding bipap... I'm thinking of terms of a pressure gradient... The force and pressure from bipap is more diffuse rather than the narrow area of an ET tube. The forced air of bipap could sneak down the esophagus compared to a secure ET tube, putting added pressure on the varices. But then again I don't know how unstable she was/how she was oxygenating/if she had a blakemore
- 1Feb 7, '13 by TraumaSurferNumerous reasons here why NOT to place someone on BiPAP. Increased pressure gradients for varices to bleed, drying of air, gastric distention on top of an already increased vomiting risk, aspiration and most importantly, if you needed BIPAP you already have a compromised airway compounded by all the other factors. Essentially, you do not have control over that airway and with a BIPAP flowing at over 200 liters/minute, you will make an already bad situation become deadly before you have a chance to do anything. The first lesson in any intervention is to assess risk factors and prevent those risk factors from becoming major issues because of **** poor planning on your part.