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  • 3.oxygen Therapy, NIPPV, and IPPV For COVID-19 PT

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    الغائب الحاضر
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    The document provides guidelines for oxygen therapy and ventilation protocols for COVID-19 patients. It discusses non-invasive positive pressure ventilation (NIPPV) for spontaneously breathing patients using tight-fitting masks, and invasive positive pressure ventilation (IPPV) which requires intubation or tracheostomy. Evidence-based practices recommend starting supplemental oxygen if oxygen saturation is below 92% and maintaining saturation no higher than 96%. For patients receiving NIPPV or high-flow nasal cannula, close monitoring is advised and early intubation in a controlled setting if worsening occurs. Low tidal volume ventilation between 4-8 mL/kg is recommended for mechanically ventilated patients with COVID-19 and ARDS.

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    3.Oxygen Therapy, NIPPV, And IPPV for COVID-19 Pt

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    The document provides guidelines for oxygen therapy and ventilation protocols for COVID-19 patients. It discusses non-invasive positive pressure ventilation (NIPPV) for spontaneously breathing patients using tight-fitting masks, and invasive positive pressure ventilation (IPPV) which requires intubation or tracheostomy. Evidence-based practices recommend starting supplemental oxygen if oxygen saturation is below 92% and maintaining saturation no higher than 96%. For patients receiving NIPPV or high-flow nasal cannula, close monitoring is advised and early intubation in a controlled setting if worsening occurs. Low tidal volume ventilation between 4-8 mL/kg is recommended for mechanically ventilated patients with COVID-19 and ARDS.

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    12 views17 pages

    3.oxygen Therapy, NIPPV, and IPPV For COVID-19 PT

    Uploaded by

    الغائب الحاضر
    The document provides guidelines for oxygen therapy and ventilation protocols for COVID-19 patients. It discusses non-invasive positive pressure ventilation (NIPPV) for spontaneously breathing patients using tight-fitting masks, and invasive positive pressure ventilation (IPPV) which requires intubation or tracheostomy. Evidence-based practices recommend starting supplemental oxygen if oxygen saturation is below 92% and maintaining saturation no higher than 96%. For patients receiving NIPPV or high-flow nasal cannula, close monitoring is advised and early intubation in a controlled setting if worsening occurs. Low tidal volume ventilation between 4-8 mL/kg is recommended for mechanically ventilated patients with COVID-19 and ARDS.

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    of 17

    Principles of Oxygen Therapy, NIPPV,

    and IPPV for COVID-19 Patient


    Ventilation protocol
    Non-invasive positive pressure ventilation (NIPPV)- including High-flow
    nasal oxygen therapy)
    • Not intubated
    • Spontaneously breathing pt.
    • Tight-fitting mask
    • Ventilator supports each breath
    • Need –ve pressure rooms
    • IPPV
    • Intubation/tracheostomy
    • Partial support:
    SIMV(Synchronized intermittent mandatory ventilation)
    - Pressure support
    -ASV (Adaptive Support Ventilation)

    Full support:
    CMV Continuous mandatory ventilation : AC/VC
    AC vs SIMV
    Evidence-based practices

    •Start supplemental oxygen


    •if the peripheral oxygen saturation (Spo2)is < 92%

    •In adults with COVID-19 and acute hypoxemic respiratory failure on


    oxygen, SpO2 is maintained no higher than 96%. Strong
    Evidence-based practices, cont’d

    •In adults with COVID-19 receiving NIPPV or HFNC, close monitoring for worsening respiratory
    status, and early intubation in a controlled setting if worsening occurs. Best practice statement

    •In mechanically ventilated adults with COVID-19 and ARDS, use low tidal volume (Vt) ventilation
    (Vt 4-8mL/kg of predicted body weight), over higher tidal volumes (Vt>8mL/kg). Strong

    For mechanically ventilated adults with COVID-19 and moderate to severe ARDS, use a higher PEEP
    strategy, over a lower PEEP strategy. Remarks: If using a higher PEEP strategy (i.e., PEEP > 10cm
    H2O), clinicians should monitor patients for barotrauma. Strong
    Mechanical Ventilation for COVID-
    19 Patient-Pressures and Recruitment
    Maneuvers
    Criteria for ventilatory support
    Parameter Ventilation is No vent.
    indicated
    1. pulmonary function:
    RR/min. < 35 10-20
    Tidal volume >5 6-8
    Vital capacity (mL/kg BW) > 15 65-75
    Maximum inspiratory force (cm H2O) > - 20- 75-100
    Parameter Ventilation is indicated No vent.

    2. ABGs

    PH > 7.25 7.35-7.45

    PaO2 (mmHg) > 60 75-100

    PaCO2 <50 35-45


    Why do we care?
    • Ventilators… may save lives
    • BUT…..
    Infections occur
    Baro truam
    Volutrauma
    atelectrauma
    Basic concepts

    Oxygenation- O2 delivery Ventilation- CO2 clearance


    FIO2 Tidal Volume
    PEEP Minute volume
    Mean airway pressure RR

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