Presented by:

Angie Barrera, SRTSherry Gow, SRT

Bill Hale, SRTYvonne Allard, SRT

Krystal Patterson, SRT

BIOLOGICAL QUESTIONBIOLOGICAL QUESTION

DO VITAL SIGNS CHANGE AS PRESSURES ARE INCREASED WHILE ON BIPAP?

HYPOTHESISHYPOTHESIS

WE HYPOTHESIZED THAT BY INCREASING PRESSURES DURING THE USE OF BIPAP WE

WOULD CAUSE AN INCREASE IN VITAL SIGNS SPECIFICALLY IN THE DIASTOLIC BLOOD

PRESSURE.

Objective: To determine the variation in vital signs during different levels of Bipap. Total n=12, 4 out of the 12 was unable to complete the study.

Methods: We surveyed 12 test subjects on three different levels of Bipap; 7/4, 10/7, and 13/10 a preliminary set of vital signs were taken at the beginning of each set of test.

Method Cont…and again between each pressure change at this time the HR, BP, RR, and Spo2 were monitored in three minute intervals.

Results: Only 8 out of the 12 test subjects were unable to complete the test, 4 test subjects complained of headaches after the first pressure change and requested that the testing be terminated at that time.

Observation: It was also observed that each test subject suffered from dry or glassy eye. We saw an 8% change in the subjects RR and BP and a 7% change in the Spo2 and HR during pressure changes.

Conclusion: The rise and fall in each parameter measured only varied a small amount. Increase of pressure during Bipap to the level of 13/10 does not seem to have a vary big impact on a persons HR, BP,RR or Spo2

BiPAP stands for Bi-level Positive Airway Pressure. It is a breathing apparatus that helps people get more air into their lungs delivered through a mask set at one pressure for inhaling and another for exhaling. It is especially helpful for patients with congestive heart failure and those with sleep apnea.

Advantages of rapid application are avoidance of intubations, preserves natural airway, patient’s comfort, maintenance of speech and swallowing, need for less sedation and ability to have intermittent use. In acute care settings respiratory rate, heart rate and gas exchange should improve within 30 min to 2 hrs after the initiation of NIPPV.

In chronic care settings improvement in gas exchange may require weeks to months depending on daily use and overall compliance with the prescribed therapy, (Egan’s 1076).

Disadvantages includes patient’s inability to cooperate, limited access to airway suctioning in persons who need suctioning, mask discomfort, facial ulcers

[unlikely in the short timeframe of this study], eye irritation, dry nose, air leaks [unlikely in persons not subject to air trapping], transient hypoxemia in already hypoxic persons. BiPAP is limited to 20-30 cm H2O and is a time-consuming procedure, (Egan’s1014).

Thoracic effects of Bipap include increased intrathoracic pressure, compression of the pulmonary vessels, which could result in reduction in the stroke volume, and reduction of cardiac output and pulmonary blood flow, (Chang 199).

GLOSSARYGLOSSARY

Acute care- health care delivered to patients experiencing sudden illness or trauma.

Air trapping- also called gas trapping, is an abnormal retention of air in the lungs after expiration.

Airway suctioning-removal of airway secretions by inserting a suction catheter into the patients oral airway and/or trachea.

Alveolar ventilation- the movement of air into and out of the alveoli. Atelectasis- a process within the lung tissue where air is lost and the

area collapses BIPAP- (bi-level positive airway pressure) a spontaneous breath mode

of ventilator support, which allows separate regulation of the inspiratory and expiratory pressures.

Cardiac Output (CO) - the amount of blood pumped out of the left ventricle in one minute

GLOSSARY CONT…GLOSSARY CONT… EPAP- (expiratory positive airway pressure) the application of

positive pressure to the airway during expiratory only (as opposed to continuous positive airway pressure).

Gas exchange- the oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.

Hypercapnia- the abnormal presence of excess amounts of carbon dioxide in the blood (in arterial blood a PCO2 greater than 45 torr).

Hypoxemia- decreased oxygen tension (oxygen concentration) of arterial blood, measured by arterial oxygen partial pressures (PaO2) values.

ICU- (intensive care unit) a special hospital unit for patients who, because of the natural of their illness, injury or surgical procedure, require almost continuous monitoring by specifically trained staff.

Intrathoracic- within the thorax Intubation- passage of a tube into a body aperture specifically the

insertion of a breathing tube through the mouth or nose into the trachea to ensure a patent airway for the delivery of anesthetic gases and oxygen or both.

GLOSSARY CONT…GLOSSARY CONT…

CHF- (congestive heart failure) an abnormal condition that reflects impaired cardiac pumping. It is caused by myocardial infarction, ischemic heart disease or cardiomyopathy.

COPD- (chronic obstructive pulmonary disease) a group of debilitating, progressive and potentially fatal lung diseases that have in common increased resistance to air movement, prolongation of expiratory phase, and loss of the normal elasticity of the lung.

We attached a bacteria filter to the tubing circuit to protect the patient from inhaling any bacteria.

We began with 5 minute health questionnaire, followed by a 5-minute physical that included getting baseline blood pressure, heart rate and respiratory rate [called vital signs]. The total time on the Bipap machine typically did not exceed 20 minutes

The purpose of this study was to monitor the effects of alterations of airway pressures via the BiPap machine on the heart rate, respiratory rate and Sp02 and systemic blood pressures of healthy adults. We selected healthy adults (18-80) both male and female, chosen from a small rural college area.

Those selected were healthy with no lung problems such as asthma (uncontrolled), COPD or emphysema or cardiac problems. These factors eliminated certain people from doing this test if they had any history with chronic lung disease or problems.

After a self test the patient placed the filter in their mouth and the test begun.

We then changed the modes after the patient was on the machine every 3 minutes

The settings we used were IPAP/EPAP 7/4, 10/7 & 13/10

We recorded these vital signs and compared them as each pressure was changed. We monitored the patient for any alteration of vitals, and noted these changes.

In our study the following modes and pressures were used to see if this study demonstrated any significant change in the vital signs. The different modes were 7/4, 10/7, and 13/10. This was a small sample survey. We did discover the following alterations, increasing all of the following: respiratory rate 8%, heart rate 7%, and blood pressure 8%.

Raw Data

Patient Statistics   Total n=12 8/12 Completion, 4/12 unable to complete

Mean Preliminary (12/12) HR 78.8 RR 15.5 Sat 99% BP 114/70

Range (Heart Rate)

Preliminary (12/12) HR 67-91

7/4 Mode (10/12) HR 64-93

10/7 Mode (9/12) HR 53-90

13/10 Mode (8/12) HR 57-95

Range (Respiratory Rate)

Preliminary (12/12) RR 13-18

7/4 Mode (10/12) RR 15-24

10/7 Mode (9/12) RR 14-20

13/10 Mode (8/12) RR 18-20

Range (Blood Pressures)

Preliminary (12/12) BP 110/80

7/4 Mode (10/12) BP 120/82

10/7 Mode (9/12) BP 108/82

13/10 Mode (8/12) BP 124/90

0

10

20

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40

50

60

70

80

90

HR RR

Preliminary (12/12)

7/4 Mode (10/12)

10/7 Mode (9/12)

13/10 Mode (8/12)

Comparison of vital signs at different

pressures

Upon completion, all test subjects had glassy eyes, and many complained of headaches

ControlBiPAP8/12 BiPAP10/15

CPAP10

HR Difference 75B7 <0.05 72B7 <0.05 70B7 <0.02 69B7 <0.01

Our limitations were that we had to use healthy patients and we were not able to see the benefits of Bipap for sick individuals. It would have been interesting to see how it actually helps patients who are really having difficulty breathing. Also we were limited on money and the amount of test subjects.

Most of our patients had a rise in the diastolic blood pressure. This was exactly what we had hypothesized before the study began. We were working with healthy patients and this is probably the reason for this change. Perhaps if we had been working on sick patients, we may have seen some kind of improvement on the vital signs such as; as rise in an already low SpO2 or decrease in high RR.

Chang, D. W. (2005). Clinical Application of Mechanical Ventilation. Belmont: Cengage Delmar Learning.

Hill, N. S. (2009). Where should noninvasive Ventilation be Delivered? Respiratory Care Journal, 54(1).

What is BiPAP? (n.d.). In WiseGEEK: clear answers for common questions. Retrieved February 05, 2009, from http://www.wisegeek.com/what-is-bipap.htm

Wilkins, R. L., Scanlan, C. L., & Stoller, J. K. (2003). Egan's Fundamentals of Respiratory Care. St. Louis: Mosby.