Procedural Skills for Medical Students
Advanced Ventilation management: Bi-Level Positive Airway Pressure (BiPAP), Continuous
Positive Airway Pressure (CPAP), Assist Control (AC), and Synchronized Intermittent
Mandatory Ventilation (SIMV)
Objectives:
1. Learners should be able to verbalize the
physiologic differences in delivery of
respiratory support between BiPAP and CPAP.
2. Learners should be able to verbalize the
difference between AC and SIMV.
3. Learners will understand the basic settings of
mechanical ventilation in AC and SIMV mode
and normal ranges of these settings in adults.
Material to review prior to lab: review CPAP versus BiPAP and Ventilator Management
BiPAP:
Indications
1. Exacerbations of COPD associated with hypercapnia.
2. Cardiogenic pulmonary edema associated with hypercapnia and/or unresponsive
to CPAP alone.
3. Respiratory distress and pulmonary infiltrates in immunosuppressed patients.
4. Acute or chronic hypercapnic respiratory failure due to chest wall deformity or
neuromuscular disease.
5. Decompensated obstructive sleep apnea with hypercapnia.
Contraindications
1. A reduced level of consciousness, which results in an unprotected airway (GCS <
10)
2. Neurotrauma associated with raised intracranial pressure or fractured base of
skull
3. Recent upper gastrointestinal surgery
4. Burns or trauma affecting the face
5. Bowel obstruction and/or vomiting
6. Severe confusion/agitation
7. Patient failure to clear respiratory secretions
CPAP:
Indications
1. To improve ventilation and oxygenation
2. To avoid intubation
3. Patients with congestive heart failure (CHF) with acute pulmonary edema
4. In near drowning patients
5. Severe respiratory distress
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Procedural Skills for Medical Students
Contraindications
1. Respiratory or cardiac arrest
2. Agonal respirations
3. Severely depressed level of consciousness
4. Pneumothorax
5. Inability to maintain airway patency
6. Major trauma, especially head injury with increased ICP or significant chest
trauma
7. Facial anomalies or trauma (e.g., burns, fractures)
8. Vomiting
9. History of COPD
10. History of Pulmonary Fibrosis
11. Decreased LOC
12. Claustrophobia or unable to tolerate mask
Mechanical Ventilation:
Indications
1. Inability to protect one’s airway
2. Hypoxic respiratory failure
3. Hypercapnic respiratory failure
4. Cardiac arrest
Contraindications
1. Advanced directives specifying no intubation or resuscitation
Equipment: HPS, mechanical ventilator, BiPAP equipment, CPAP equipment
Instructional Procedure & Endpoints:
BiPAP
1. Learners will be oriented to HPS and equipment in ASTEC.
2. ASTEC staff will discuss the physiology of BiPAP, demonstrate placement and
settings for BiPAP.
3. Learners will verbalize one indication for BiPAP.
CPAP
1. Learners will be oriented to HPS and equipment in ASTEC.
2. ASTEC staff will discuss the physiology of CPAP, demonstrate placement and
settings for CPAP.
3. Learners will verbalize one indication for CPAP.
Assist Control
1. Learners will be oriented to trainer and equipment in ASTEC.
2. ASTEC staff will discuss the settings and physiology of assist control mechanical
ventilation.
3. Learners will verbalize correctly 3 out of 5 initial vent settings of AC.
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Procedural Skills for Medical Students
SIMV
1. Learners will be oriented to trainer and equipment in ASTEC.
2. ASTEC staff will discuss the settings and physiology of synchronized intermittent
mandatory ventilation.
3. Learners will verbalize correctly 3 out of 5 initial vent settings of SIMV.
References:
Amitai, A. (2011). Methods of ventilator support. Medscape. Retrieved from
http://emedicine.medscape.com/article/810126-overview#aw2aab6b4
Esherick, J. (2011). Mechanical ventilation. In J.L. Pfenninger, & G.C. Fowler (Eds.),
Procedures for Primary Care, 3rd Ed (1415-1420). Philadelphia: Elsevier Mosby.
Martin, L. (2011). Non-invasive positive pressure therapy: CPAP, BiPAP, ASV. What are
they, and when do you use them? Retrieved from
http://www.lakesidepress.com/CPAP/CPAP.htm#table
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