NPPV and BiPap Changes Per ABG Results

[@nereac.661]

The true treasures of the internet are the 5 year old videos that are just guy and his whiteboard. 100% more useful than the fancy animations. Thank you so much for your great explanation.

[@RespiratoryCoach]

LOL! I cringe looking back at these videos, so thank you for the kind comment.

[@shanellestone4379]

Omg. I’m in my second term of RT school and I was just so lost when trying to learn about this portion of noninvasive ventilation. Thank you so much for making your videos!

[@RespiratoryCoach]

You are so welcome! Glad it helped! Thank you for watching and commenting!

[@nac2016]

OMG I NEEDED THIS!!! This helped me so much!!!!!

[@RespiratoryCoach]

Fantastic! Thank you for watching and leaving the kind comment!!!! Go be great!

[@marilyntorresrrt6763]

every time i have checkoffs, videos like these helps me refresh :)

[@RespiratoryCoach]

And this is why I created this channel. Thanks for the comment, Marilyn!!!!

[@silk.spectre6606]

This is wonderful! THANK YOU! I was pausing the video after the first example, and I got it right each time. This will be in my lab final, so thank you again for doing this!

[@RespiratoryCoach]

Cool! Hope it helped with your lab final!

[@Yp_mam]

One of the best videos for Respiratory ICU

[@mohamedalshikh6186]

im not a doctor and even my english not that good i want to tell you this video helps me to much as my father has copd and its very simple to understand, Keep going god bless you.

[@kulothungans6838]

This video is a dynamite! Bro this is an epic video. U brought somuch clarity in such a short span of time ... will remember as long as i see am ABG .... thanks bro!

[@RespiratoryCoach]

Awesome! Glad you liked it!!

[@kennethweiss9068]

Fantastic videos! As an RT for many years about to re-enter the work force after caring for mom the last couple of years, I find the material and extremely pleasant teaching manner wonderful. Thanks for this!!

[@luvinmy3bois]

It finally makes sense!! Just in time for summer finals tomorrow. THANK YOU!

[@RespiratoryCoach]

Perfect!! How did finals go, Christina? Thanks for watching and commenting!!!

[@susiecisner1736]

Thank you for helping me understand this so much better!

[@dr.manzurahmed1652]

Excellent explanation& very easy presentation but informative lectures.Thanks a lot.

[@Cindyabigail]

Thank you so much for making it clear and simple! So may videos out there that just over complicate things.

[@lydiac548]

Joe, these are so good. So clear. So helpful. Thank you!

[@frankmaggio4328]

Awesome explanation!!!!!!!!!!! When I went over bipap w some of my colleagues (I'm a Travem Nurse who always let RT manage bipap) it wasn't explained to me - the way you're explaining . I couldn't get an explanation of how to fix oxygenation vs. co2 removal. I've watched this video 8 times now. Now I'm getting it and I'm now comfortable knowing how to pick the setting! Thanks for making this video!

[@minerva944solange]

Omg.....this made so much sense to me.....ugh.....thank you soo much for the service you provide selflessly...studying is hard for some of us without examples. Thank you!!!!!😘😘😘😘😘

[@RespiratoryCoach]

Hi Mandy! You're very welcome, and I'm so glad it clarified things for you. Thank you so much for watching and commenting!!!

[@andrellaarbeary6151]

You made it so simple to understand. Thank you so much…

[@Thetimbercruiser]

New grad RN headed to the ICU. Great videos my dude 🤙🏻

[@MunecaA87]

Omg ! I am half way through this video and you have explained things in a very clear manner. My mother has been hospitalized in ICU many times this year for high cO2 levels, after last discharge they gave her a ventilator machine but the problem is that it was set up by equipment company without a proper sleep study, the guy said he was just going to set it up on a level that she’s comfortable, and I don’t think it should be that way, when she wears that ventilator and she’s sleeping o2 sat levels don’t go above 88 and they say there is no available appointments at sleep study centers until December, her c02 levels were over 90 before and last time I took her she was at 60 and they said oh well she is a c02 retainer

[@joleenaah]

Such a great and easy way to understand NPPV. THANK YOU! Im in my second semester of RT school and I feel like i hit a jackpot coming across your videos ✨✨✨✨

[@RespiratoryCoach]

You're very welcome, Joleen! Thank you for watching and kindly commenting!

[@samikshyapokharel2790]

In short of words to thank you..Please understand how big help your video was..thank you !!

[@derickasartblog835]

Thank you 1000x for this. My wheels are starting to turn.

[@starvingsum1]

If I can help you in anyway let me know. This was fantastic! I have my check offs this morning and wow, your a life saver!

[@RespiratoryCoach]

Best wishes on your check offs! Go be Great!

[@starvingsum1]

Thank you very much! I did good. I struggled on names for PFTs.. but nonetheless, I’m officially a senior now! :-). Thank you, I don’t think I’m great yet, but I’m striving for it!

[@RespiratoryCoach]

Awesome! Finish strong! 💪

[@jamlisa4696]

Where have you been all my life? I am so freaking happy I found your channel😁. You are an amazing teacher sir.

[@RespiratoryCoach]

I've been right here! So glad you finally found us!! Welcome to the FRT Community!

[@jamlisa4696]

@@RespiratoryCoach Thank you! I am binge watching your videos. So much to learn! You explain eveything so well. It’s just incredible. You are appreciated. Blessings to you and your family.🙏🏾

[@quintonwynn6471]

Bro you’re the GOAT

[@RespiratoryCoach]

Too kind Quinton! I appreciate you watching and commenting!

[@msalmankhan8339]

Sir you don't know how much effective your lecture for us I don't know before how to set I used to set bipap without making sense

[@lenahkarimi6260]

You explained it in simplicity!! Was way easier for me to understand. Subscribed for more videos. Thank you.

[@samanthafults9202]

Bless you. This made so much more sense.

[@RespiratoryCoach]

Cool! Thank you for watching and kindly commenting!!!

[@martiniasmith1446]

Even if the bicarb is out of normal range, we shouldn't worry about that

[@Vivaz79]

Thank you. Explained v well, cleared my doubts and way of dealing with the issues.

[@traceylomax2156]

Second week of orientation, listening to your videos again. Listening to u before RRT and after RRT

[@RespiratoryCoach]

Awesome, Tracey. How's orientation going?

[@clarishancheta1487]

Wish you are my professor I love the way you teach. Do you have a video on setting up the Mechanical Ventilation Machine (Hamilton G5). ❤❤

[@drshaileshbarphe4717]

Sir u hv Explained in a very simplified way. Thank u very much 🙏

[@RespiratoryCoach]

You are most welcome. Thank you for watching!!

[@heathercoyle9834]

Hello there! Your video is amazing and simplifies it all so it’s much easier to understand. Thank you! My question is on the actual state board tests it asks questions about changing the settings but they give answers like changing minute ventilation and such. It’s never as easy as you explain it. I feel like it goes into way more detail. It’s like they take it a step further in depth. Can you be owing this pretty please!!!

[@S2SStorytellingtoSucess-yq6xq]

hats off to you dear .. very well explained

[@RespiratoryCoach]

Thanks for watching and kindly commenting!

[@stefaniegunter9128]

This was the best explanation and practice of nppv... thank youuuuuu

[@tarikrafiq1846]

You are a pro . Thank you Easy explaining . You need to write a book. How to be a therapist in 5 days .

[@UMBUBA]

Loved it bro! Helped a lot. I’m a new RRT, just started working at the hospital.

[@RespiratoryCoach]

Awesome!! Welcome to the field! Go be GREAT!

[@timbailey6548]

Okay got it oxygenation problem increase epap and keep the pressure support so increase IPap as well. If the problem is ventilation then increase IPAP alone.

[@RespiratoryCoach]

Hey, Tim! Essentially yes, but there is one potential scenario to consider. Let's say a patient is placed on 15/10, but has no oxygenation issues. In this case, we could leave IPAP at 15 and decrease EPAP to 5, and that would increase PS without having to increase IPAP. Just wanted to throw that out there. Thanks for commenting and watching. Good luck on your upcoming CSE!!!

[@bayanalkhalifa1853]

Thank you so much!!! This is soooooooo helpful.

[@RespiratoryCoach]

Glad it was helpful, Bayan! Thank you so much for watching!!!

[@ahmadhassan2511]

Perfect How simply u explained it.. thanks 👍

[@tasiko6236]

Thank you from UKRAINE 💙💛 you are incredible!! Very grateful neonatologist)

[@msalmankhan8339]

You are humble at the same time and want to keep learning ❤️

[@tulip-vf3iz]

God bless you for this amazing video

[@RespiratoryCoach]

Hi, Tulip. God bless you for watching and leaving this kind comment!

[@fanyu6529]

Thank you very much!!! Finally, I can understand this annoying thing!!

[@nishadrangana3727]

Why we shouldn't change EPAP setting, Unless have any changes in PaCO2?

[@RespiratoryCoach]

I'm sorry, I don't your question. Please clarify.

[@nishadrangana3727]

Sorry... i asked that if there is an any changes in PaO2, why we are always focus on EPAP, not on IPAP

[@stryderhiryu8]

@@nishadrangana3727 because the EPAP works like PEEP.. to which.. it suffice the Alveoli the right needed oxygen amount.

[@timbailey6548]

Thank you trying to understand cse practice exams and have it coming up soon

[@dr.tabassum2859]

Thank you sooo much!! It helped a lot! Thanks a lot!

[@jeckellstallworth]

Excellent video as always! Thank you

[@RespiratoryCoach]

Hey, Jay! Thanks man. I always appreciate your presence on the channel.

[@rajender686]

Simple and informative....that's all we need....nice

[@RespiratoryCoach]

I agree! Thanks for watching and commenting!

[@kimms8610]

Thank you I was struggling to under stand this concept. Amazing explanation..thank you so much.

[@RespiratoryCoach]

You're very welcome, Kim. Glad it helped, and I appreciate you watching!

[@СвятозарПупкин]

Thank you I was struggling to under stand this concept. Amazing explanation..thank you so much.

[@policegadi]

Such a clear explanation.. wonderful

[@RespiratoryCoach]

Thank you, Dr. Walke!

[@bezaadmassu4922]

Ahh thanks for simplifying this subject! Super helpful

[@RespiratoryCoach]

Glad it was helpful!

[@desimotto9725]

Great review. You connected the dots for me

[@RespiratoryCoach]

Awesome! Thank you!

[@JB-cg1rn]

Very helpful. Thank you so very much!

[@mohamedhabibberhanu6553]

Awesome job coach I really enjoyed it

[@RespiratoryCoach]

Awesome, thank you!

[@kristenplotner8845]

This was so helpful! Thank you!

[@RespiratoryCoach]

You're so welcome! Thank you for watching and commenting!!

[@carissababyy12]

Awesome video. Thank you for this, it helped sooo much!!

[@zakilivoali2504]

Great work man. Can you do a video on CPAP

[@griseldagonzalez5121]

Great explanation. Love all your videos.

[@RespiratoryCoach]

Well thanks for watching, and thanks for the kind comment!

[@the_resilient1977]

Thank you soooo much! This video was very helpful 🙌🏾

[@RespiratoryCoach]

Glad it helped. Let me know whenever I can help with whatever.

[@munyrahxz1540]

Thank very much, I really like your videos ❤️

[@RespiratoryCoach]

Thanks, Munyrah! I really appreciate you watching and commenting.

[@joannefurman2196]

Your explanations are very clear. Can you provide an example of a ventilation and oxygenation problem?

[@RespiratoryCoach]

Hi Joanne. First, thanks for watching and posting your question. An oxygenation problem would be a patient who's PaO2 is below normal, say 54. Or might be indicated by a low saturation, say 84%. You might also say a patient had an oxygenation problem if their PaO2 was 80, but they were requiring 80% oxygen to achieve that. A ventilation problem would best be illustrated by a patient with a high CO2 (65) and a low pH (7.15), or a patient with a normal CO2 and pH, but is requiring 12lpm of minute volume to achieve that normal gas. Does that help clarify? Let me know if not.

[@joannefurman2196]

@@RespiratoryCoach Yes, but I was wondering how you would adjust the settings for the IPAP & EPAP if there was an oxygenation and ventilation problem. Let say a patient who has a CO2 rate of 31 and is moderately hypoxemic?

[@RespiratoryCoach]

I see, Joanne. So if your CO2 is 31, which means it's low, then you need to decrease the difference between IPAP and EPAP, which you could easily do by increasing EPAP to address the moderate hypoxemia. So if the patient was on 12/5, then increasing the EPAP to 8, would now put them on 12/8. Your pressure support is lower thus your CO2 should return to normal, and with the added EPAP hopefully your hypoxemia will correct. Let's say your patient was on 10/5 and their ABG came back with a high CO2 and a low O2. Then to address the low oxygen we would increase EPAP, let's say to 8. To address the high CO2 we need to increase the PS, which we know is the difference between IPAP and EPAP. If we placed IPAP on 13, we would do nothing for the high CO2 because the difference is still 5. So we would need to increase the IPAP to 15 or 18, now our PS is 7-10, which is an increase from 5 and our CO2 should come down. Does that answer your question?

[@joannefurman2196]

@@RespiratoryCoach Yes! Awesome!!! Thank you for your help!!!!

[@nishadrangana3727]

I gathered more information from u.. thanks a lot sir..

[@joshuacastruita8052]

Great video bro, thank you.

[@PravinChandran1983]

Very nice , simple and understandable, thanks for sharing and your efforts , kind of you 👍👏👏🙂

[@wasimraja301]

Very good appreciate ur work, can u pls make video on oxygen therapy, which mode of oxygenation should be used in which setting,when to use high flow system when to use low flow system, when to use Nasal canula,face mask,high flow nasal canula,NRBM etc.

[@brianwestgate7055]

I feel like we kept FiO2 out of the conversation, in regards to oxygenation. If the patient feels comfortable with the support settings, yet values show oxygenation issues, you can keep the support settings while supplementing oxygen by way of FiO2.

[@saeedahmad4851]

A bundle of thx for the simplified and comprehensive explanations. Sometime we come across patients with type 2 respiratory failure having high CO2 levels and low Oxygen concentrations. e.g 7.21/68/46/16/73% Although such critical patients do need intubation but still if we can't intubate them then what will be the best settings for BIPAP.

[@RespiratoryCoach]

Hi, Saeed! For that gas you provided, if I were going to attempt NIV first (probably wouldn't, but let's just go with it)I would be aggressive with my EPAP setting to maximize oxygenation, as well as an aggressive IPAP setting to maximize ventilation. So IPAP 20 / EPAP 10. Watch my return tidal volume, minute ventilation, patient presentation, Sp02, reassess a gas in 30 minutes and hope for an improvement. If those settings don't show improvement fairly quickly, this patient needs to be intubated. Hey, thanks for watching and offering this example!

[@rajasekharthottadi5151]

@@RespiratoryCoach than you

[@Lungs523]

I hope you know that you definitely make a difference in our learning for the better!!! Thanks a million😊I truly appreciate the x u take to do these awesome videos that help us so much 🥹🤛🏼

[@dhandapani9870]

Thanking GOD for you🥳

[@gracedodd2191]

most helpful channel on youtube

[@RespiratoryCoach]

Wow, thanks! I appreciate you watching and kindly commenting!!!

[@dinapoole9018]

good job explaining .

[@janabhuvan9686]

Tq so much sir teach about ventilator settings

[@RespiratoryCoach]

You are so welcome! Thank you for watching and commenting!!

[@Vanillakd]

Thank you so much for this video! Definitely had a light bulb moment when I watched it lol :-D

[@helenosawe6327]

please do teaching on how to do vent check, the most important parameters to monitor and how to make adjustments. Thanks

[@naazbano4490]

Awesome...I just needed this

[@hunterburton82]

Awesome video buddy

[@RespiratoryCoach]

Thanks buddy! I appreciate you watching it!

[@rickpelow1861]

These are best RRT info on youtube. Can you explain when you have settings of epap min and epap max how to increase oxygenation

[@stryderhiryu8]

It expands the alveoli.. thus the very essential part of lungs are well suffice with oxygen.

[@pratikshasutar4328]

Well explained thanks a lot ! Ur channel is a blessing 🙏

[@saaldos8395]

Thank you so much! you helped aloooot

[@honeyb0625]

Thanks, life saver

[@RespiratoryCoach]

Hi! Thanks for this kind comment and for watching!!!! Best wishes!

[@vangtran2055]

Do we need to take FiO2 into consideration? Will high IPAP (20) cause any harm to the patient?

[@irinaostapenko7017]

Thank you so much!

[@Marzyattakz]

Yasssss!!! So good !!!!!

[@RespiratoryCoach]

Here to help, so just let me know what you need.

[@kennethgillespie8351]

It makes just a little bit harder to understand with the increases and the original settings are the same number.

[@duylong1595]

Omg. Tks so much

[@RespiratoryCoach]

You're welcome! Thank you for watching and commenting!!!

[@appleipad1177]

Thank you for such a wonderful lecture

[@gk3568]

Great video thanks a lot . Can you explain the expiratory and inspiratory triggers in ST bipap mode ?

[@dlewispromed]

This was a great explanation, I wish I'd watched it before checkoffs. Will you go over how the HIP and LIP alarms are set and what the LIP T alarm is used for?

[@AliljaJfk]

Wonderfuly explained ❤

[@RespiratoryCoach]

Thank you for watching and commenting!

[@shanu0012]

You made it look like 'school kid doing simple math' easy.. Kudos..

[@RespiratoryCoach]

That's my goal!! Thank you for the comment and for watching.

[@cheftommy]

thank you so much !

[@tonyawright7708]

What recommendations for a COPD patient with ph of 7.46, PCO2 of 66, PO2 of 119, and HCO3 of 39.9?

[@2005001991]

Thank you for this

[@amrindergill6990]

Superb information, Cleared all doubts. Dr advised my father to put on Bipap. Just want to know which mode it should run like ST etc

[@marilyntorresrrt6763]

YOU ARE A LIFE SAVER> this helped me so much. I appreciate it. Now im ready for Wednesday, very confident. Will keep you posted :)

[@RespiratoryCoach]

I don't know about that. Lol. Just doing what I can to help.

[@samraahmad2157]

We have e vents in covid and they have modifications in their modes kindly make a video on it

[@stryderhiryu8]

Same suggestions

[@Arpit4063]

Great work, but how does the situation change when FiO2 factor comes in. case in point a normocapnic hypoxemic patient, should i increase fio2 or epap. much thanks

[@mitchkrdr]

How would you know how much to go up when you make adjustments? Like when you went up by 5 and by 4 on your IPAP and EPAP to address oxygenation problem but keeping your PS the same.

[@arun4udude]

How much should be the change IPAP/ EPAP / PS Will it damage the lungs?