Non-invasive mechanical ventilation NCPAP and BIPAP

This is an automatically translated article.

This article is professionally consulted by Master, Doctor Nguyen Le Duc Hoang - Emergency Medicine Doctor - Emergency Department - Vinmec Danang International Hospital.

CPAP (Continuous positive airway pressure) - continuous positive pressure ventilation. BIPAP (Bilevel positive airway pressure) - ventilation with two thresholds of positive pressure. These are two methods of non-invasive ventilation that are widely used in emergency resuscitation units, especially in neonatal resuscitation.

1. Indications and contraindications of 2 methods

1.1. Indications Both methods are indicated for respiratory support in cases of respiratory failure but still breathing, specifically as follows:
Premature babies with endocardial disease, showing signs of apnea, dysplasia bronchi in the lungs. The patient is weaned off the ventilator. Pneumonia, delayed pulmonary drainage, pulmonary hypertension, pulmonary edema, pulmonary bleeding Mild to moderate meconium aspiration syndrome. Tracheal musculoskeletal, soft larynx. BIPAP is used preferentially in the following cases:
CPAP execution failed. Weaning of pediatric patients must use invasive ventilation or babies born very prematurely, with extremely low birth weight. Use immediately after giving birth or after performing INSURE, Surfactant therapy.

1.2. Contraindications Contraindicated to use in the following cases:
Undrained pneumothorax. Esophageal fistula. Increased intracranial pressure: meningitis, cerebral hemorrhage. Deformity of atrophy of the posterior nostril. Severe cleft palate, severe nosebleed. Air bubbles appear in the lungs. Shock from any cause. Diaphragmatic hernia Necrotizing enterocolitis or intestinal obstruction.

2. Prepare before doing

Performers: Specialist doctors, nurses are trained to use machine proficiently.
Facilities: CPAP or BIPAP ventilator, Nasal bridge Sonde, suction Sonde, fixed bandage, sterile gloves, suction machine, heart rate monitor, spO2, blood pressure.
Patient: To be explained about the operation of the machine, the patient needs to have a guaranteed body temperature.
Medical records: Full according to regulations

3. Steps to take

3.1 General steps to take After carefully examining the medical record, perform the technique, the specific operations are as follows:
Initial preparation
Posture: intermediate Place the nose CPAP frame for Pediatric patient carefully Check the ventilator for normal operation, including: wiring, tanks are properly installed and sealed, and set the readings according to the patient's flow rate. Prepare a CPAP/BIPAP ventilator
For a CPAP machine, pour water into the pressure vessel and humidifier at the specified level. Connect the ventilator system to the oxygen and compressed air system. Set the CPAP pressure level. With CPAP variable flow and BIPAP adjust flow to achieve desired pressure level, typically starting from 5-6cm H2O. Set baseline CPAP level 4-6 cm H2O, threshold CPAP level 2 to 3 cm above baseline CPAP level. T-high 0.5- 1 Frequency 10 – 30 Appropriate temperature and humidity settings: The temperature is usually set from 36-37.5 degrees Celsius, and the humidity is about 50%, if the weather is dry, it can be adjusted. increased to 80%. Adjust the FiO2 value With CPAP water column: Adjust the flow of oxygen and compressed air so that the desired oxygen concentration in the inhaled air is achieved. Normally start at a 40% FiO2 value and bubble up steadily. With CPAP changing flow and BIPAP, we proceed to turn the knob FiO2 Turn on the alarm light Connect the CPAP/ BIPAP machine to the patient.

3.2 Steps to perform CPAP breathing through the Benveniste valve Assembling the continuous positive pressure breathing system
Open the humidifier and place the blotting paper in the coil and reattach the humidifier. Then proceed to pour sterile distilled water into the humidifier. Attach the flowmeter plug to the valves of the compressed air and oxygen tanks. Notice how the specified color of the oxygen hole is white and the air hole is black. Place the humidifying chamber in the warmer Install the wiring
Install the air ducts from the air mixer to the humidifier. Attach the ventilator line, attach the thermometer from the humidifier to the water trap, and to the three thermometer attachments. Place the water trap lower than the patient, with the thermometer dial facing forward. Attach the cannula to the Benveniste valve Plug the power into the mains 220V and then turn the “ON” button on the kettle and adjust the temperature knob so that the kettle temperature is kept within 33 ± 10 degrees Celsius. Turn on the oxygen flow and Air according to the doctor's order, check the pressure. Fix the cannula to the patient's nose. Assess the patient's condition after performing the technique
Breathing rate, apnea, level of exertion. Peripheral perfusion, vascular. spO2 Respiratory failure (thoracic indrawing, moaning, nasal flapping) Discharge, nasal skin color, abdominal distention, gastric juice, comfort of the child.

4. Follow up

Monitor the ventilator's performance. Monitor the patient's condition, so wean off the ventilator as soon as possible. If severe respiratory failure requires intervention with an invasive ventilator. Monitor and combine other combination therapy. After feeding the child, the gastric tube should be opened to avoid causing difficulty breathing. In the process of performing NCPAP and BIPAP non-invasive mechanical ventilation, if the child has complications such as placing the catheter too deeply, nose damage, CPAP catheter blockage, infection,... then it should be handled according to the situation and instructions. specialist.
Non-invasive mechanical ventilation is performed at Vinmec International General Hospital with a highly configured ventilator system for ICUs for adults, children and infants.
In particular, the team of doctors performing the technique are all doctors from the Emergency Department with high professional experience.
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