CPAP

Indications:

Respiratory failure (pO2 < 55mgHg, pCO2 > 60mmHg) despite high flow oxygen/maximal medical treatment

    e.g.

    Acute pulmonary oedema

    COAD (BIPAP is better)

    Pneumonia

    Asthma (controversial and may worsen hyperinflation)

Contraindications (these patients will need intubation and mechanical ventilation)

    Loss of gag reflex

    Obtundation

    Pre-arrest

Procedure

Connect CPAP machine to oxygen and air wall source

Set FiO2 initially  to 100% (using oxygen/air blender and calculation table on machine)

    Attempt to achieve maximum total flow rate allowable for any given FiO2

    N.B. Avoid SaO2 > 93% in CO2 retention and titrate FiO2 downward quickly aiming around 93% and check ABG early

Set PEEP at 5 cmH2O increasing 1-2 cmH2O every minute until SaO2 > 93% to Maximum of 15cmH2O

Sit patient upright (unless hypotensive)

Place mask harness behind patient's head

Attach mask firmly to patient's face ensuring air-tight seal (hold mask to face temporarily whilst straps being fastened)

Patient requires nurse special

Observe closely for aspiration/vomiting, hypotension, non-response to treatment, hypoxia, worsening mental status

Nursing observations (minimum)

Complications

Problems - how to address

    Hypotension

    Hypoxia

    Worsening mental state

    Patient 'fights' mask

Weaning (under medical instruction)

Criteria for stopping CPAP

Criteria for starting mechanical ventilation