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SUBJECT: Full Mask CPAP for atelectasis or hypoxemia cardiogenic pulmonary edema.

PURPOSE: To define procedure for administration of CPAP by full face mask in the treatment/prevention of atelectasis or treatment of hypoxemia.

POLICY: Patients with orders for CPAP by mask for treatment/prevention of atelectasis or treatment of hypoxemia - cardiogenic pulmonary edema.

PROCEDURE:

1. Procedure is explained to patient. Breath sounds are assessed, pulse and blood presure are taken.

2. Proper size mask (mfg: Vital Signs) is chosen.

3. "Down's Flow Generator" (mfg: Vital Signs) plugged into wall oxygen is hooked to large bore aerosol tubing with calibrated oxygen analyzer "T'd" in line. This tubing is attached to the inspiratory port of the face mask and a pressure manometer is connected to the mask.

4. Attach CPAP valve:

For atelectasis treatment/prevention: A 15 cmH2O (or other pressure if specified by order) CPAP valve (mfg: Vital Signs) is attached to the expiratory port of the mask.

For hypoxemia, cardiogenic pulmonary edema: A 10 cmH2O (or other pressure if specified by order) CPAP valve (mfg: Vital Signs) is attached to the expiratory port of the mask.

5. Headstrap (mfg: Vital Signs) is placed on patient and high flow is started to the mask from the "Down's Flow Generator".

6. Desired inspired oxygen percentage is obtained by adjusting the FIO2 control on the "Down's Flow Generator" while monitoring the oxygen analyzer. Mask is then placed on the patient and secured by the headstraps with just enough tension to provide a leak free seal.

7. One way flap on CPAP valve is visualized and flow from "Down's Flow Generator" is adjusted to provide enough flow to keep the flap open during inspiration yet maintain 15 cmH2O pressure reading on the pressure manometer.

8. Patient tolerance is assessed. Blood pressure and breath sounds are checked periodically during and upon completion of treatment. Pulse and SpO2 are monitored continuously.

9. CPAP for atelectasis treatment/prevention is carried out for 30 minutes if tolerated. Treatments are done Q1w/a-Q4w/a or as ordered. CPAP for treatment of hypoxemia is maintained on a continuous basis or as ordered.

Sources/References:

Duncan SR, Negrin RS, Mihm FG, Guilleminault C, Raffin TA. Nasal continuous positive airway pressure in atelectasis. Chest 1987; 92:621-24.

Anderson JB, Olesen KP, Eikard B, Jansen E, Qvist J. Periodic continuous positive airway pressure, CPAP, by mask in the treatment of atelectasis. Eur J Respir Dis 1980; 61:20-25.

Davies CA, Grant IS. Total collapse of lung and CPAP (letter). Anesthesia 1987; 42:780.

Thommi G. Nasal CPAP in the treatment of persistant atelectasis (letter). Chest 1991; 99:1551.

Fried JL, Downs JB, Davis JEP, Heenan TJ. A new venturi device for administering continuous positive airway pressure (CPAP). Respiratory Care 1981; 26:133-136.

Bersten AD, Andrew WH, Vedig AE, et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991; 325:1825-30.

Rasanen J, Keikkila J, Downs J., et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol 1985; 55:296-300.

Stock MC, Downs JB, Gauer PK, Imrey PB. Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Chest 1985; 87(2):151-157.