Duovent (bronchodilator) nebulizer and CPAP therapy

[Pneumophile]

Why on earth would you assume that?

The therapist would use the nebulizer in conjunction with CPAP when in their professional judgement doing so is preferable to the alternative. Certainly that would include when the patient is asleep and waking them up would not be preferable. I would trust the professional opinion of a pulmonary therapist over the absurd ranting of some forum poster, any day of the week.

[allenrcp]

O boy this one got off in the weeds...

you seem to have missed the point.

I believe, you sir, are missing the point. PEEP (invasive) and EPAP (noninvasive) are two different languages.

I would trust the professional opinion of a pulmonary therapist over the absurd ranting of some forum poster, any day of the week.

I really try not to absurdly rant. The original post asked if anyone had seen this (nebulizer in conjunction with a CPAP mask) done. I've seen it done. I didn't say not to do it. I just suggested it would be better to place the nebulizer close to the mask versus not. I'm also a therapist.

[palerider]

O boy this one got off in the weeds...

you seem to have missed the point.

I believe, you sir, are missing the point. PEEP (invasive) and EPAP (noninvasive) are two different languages.

your initial allegation:

On a vent the terminology changes from CPAP to PEEP.

however:

BiPAP is equivalent to PSV (pressure support ventilation) + PEEP (positive end-expiratory pressure) in the intubated patient; in that situation PEEP is the same as EPAP.

http://www.lakesidepress.com/CPAP/CPAP.htm

In the setting of NPPV, EPAP is the same as PEEP (Positive End Expiratory Pressure).
In other circumstances, PEEP can refer to:

• resistance to expiration from airway structures like the nasopharynx (physiologic PEEP).
• incomplete expiration due to airways disease or breath-stacking during mechanical ventilation (intrinsic or auto-PEEP).
• a ventilator setting in invasive ventilation (extrinsic PEEP).
• a high frequency noise made by an alarmed mouse.

http://schemergency.com/stem/unmasking-bipap

Important to clarify which terminology is being used because some specialties will use the first number to refer to the IPAP (respiratory), whilst others will mean the pressure support. For example, 12/6 could mean an IPAP of 12 and an EPAP of 6 OR potentially a pressure support of 12 and an EPAP/PEEP of 6 (making the IPAP 18)

http://www.onthewards.org/files/9314/24 ... _final.pdf

point being "On a vent the terminology changes from CPAP to PEEP." does not appear to be a valid statement, as I said in the first place.

[allenrcp]

On a vent the terminology changes from CPAP to PEEP....PEEP is used to aid in the recruitment of collapsed alveolar sacs on patients with refractory hypoxemia whereas CPAP prevents pharyngeal airway collapse during sleep.

was said in response to

As I understand it, patients on Ventilators are intubated and don't need CPAP.

Establishing a viewpoint of mechanical ventilation through the lens of sleep terminology. It just struck me as funny in an ironic way because CPAP is basically a homonym having one meaning in the sleep world and one for the mechanical ventilation world.

People on a ventilator get PEEP to stint open their collapsed alveolar sacs the same way people with OSA get CPAP to prevent their soft palate from collapsing.

CPAP is useless as a stand alone mode of ventilation for a mechanically ventilated patient. And therein being my point. If CPAP is given it is primarily used with pressure support as a weaning method. So CPAP (code for preventing oropharyngeal airway closure/obstruction) in the sleep sense, does not exist in the mechanically ventilated patient. PEEP, producing the same physiologic affects, is used and you cross over into the world of mechanical ventilation.


I can't post it here because its copy written information but Egan Fundamentals of Respiratory Care 11th edition is a superb choice for all topics respiratory.

[palerider]

On a vent the terminology changes from CPAP to PEEP....PEEP is used to aid in the recruitment of collapsed alveolar sacs on patients with refractory hypoxemia whereas CPAP prevents pharyngeal airway collapse during sleep.

was said in response to

As I understand it, patients on Ventilators are intubated and don't need CPAP.

Establishing a viewpoint of mechanical ventilation through the lens of sleep terminology. It just struck me as funny in an ironic way because CPAP is basically a homonym having one meaning in the sleep world and one for the mechanical ventilation world.

I'll just remember that 'funny' trumps 'right' in your book.

[avi123]

I believe that PEEP is actually analogous to EPAP, since it only refers, by definition, to (Positive) End Expiratory Pressure, whereas CPAP also is referring to IPAP, and in all but the most simple cpaps, the IPAP and EPAP can be different.

Speaking in terms of ventilator settings the physiologic effects of CPAP and PEEP are increased FRC. In that way, EPAP will also have the same FRC increasing effect. No vent order I have ever heard includes EPAP unless we are talking NIPPV and then it is half of a BiPAP order.[/quote]

Comment,
When you set the EPR on your CPAP for expiration to make it easy to expirate you then essentially also do a Positive End Expiratory Pressure to keep those alveoli expanded and not letting them collapsed completely. Then you need less pressure on inspiration to open them up again.

[palerider]

When you set the EPR on your CPAP for expiration to make it easy to expirate you then essentially also do a Positive End Expiratory Pressure to keep those alveoli expanded and not letting them collapsed completely. Then you need less pressure on inspiration to open them up again.

spoken like someone who doesn't understand the concept.

[chunkyfrog]

Set the EPR to "infinite" so he can expire.