Operations Skills for CPAP Machine

Treatment Principle

OSA (Obstructive sleep apnea)

The main problem of OSA is upper airway collapse;
Common reaction of airway collapse : mouth breathing, snoring, and apnea;
The basic function of CPAP machine is to ensure smooth flow of the airway;
The CPAP is able to provide Continuous Positive Airway Pressure through mask to patient, which can reach the ideal treatment affect.

Performance Parameters

Auto CPAP：Stable Pressure
If CPAP pressure output unstable, it can cause pressure fluctuations in the mask. The CPAP machine can continuously adjust the motor speed by sensing pressure fluctuations, keep the pressure inside of mask stable.
The easy way to test a CPAP pressure is: connect a pressure meter to the mask, set the pressure to 10cmH2O, and breathe naturally (do not breathe deeply) with the mask. Qualified machine: pressure fluctuation within ±1cmH2O, good machine within ± 0.5cmh2o. If more than ±2cmH2O, that CPAP machine is unqualified.

Operation Skills for CPAP

The Key Step Before Use

The Key for first time use CPAP/BIPAP: wear the mask properly.

Process: (wear the mask before use the machine)

Introduce nasal/ full mask structure and function; especially vent hole;
Clear introduction: adjust the tightness of wearing;
Wearing method: slightly tight at below headgear, slightly loose at above headgear;
Do not connect to the machine, let user lie down( or half lying) only wear the mask to breath more than 15 minutes ;
Practice proper use of nasal/full mask in front of a mirror.

The Main Factors Leading to Failure Treatment

Mask Air Leakge

Failure to wear the mask resulted in severe air leakage and insufficient pressure inside the mask. The tightness of the mask is based on the principle of no air leakage.

Improper adjustment of pressure parameters.
Others: poor machine performance, large pressure fluctuations in the mask; improper adjustment of the degree of humidity, etc.

The Principle of Setting CPAP Pressure for the First Time

Pressure can be set a little higher, the higher pressure is better than the lower one.

Auto CPAP Parameter Setting:

Determine the starting pressure
User lies down, the pressure starts from 4cmH2O (higher for heavier patients), Then increase the pressure gradually . The pressure that the patient feels better is set as the initial pressure.The default parameter is 6cmH2O for women and 8cmH2O for men.
When the treatment pressure is not clear, the minimum pressure can be set as the initial pressure; The maximum pressure is determined by the severity of the patient (referring to the AHI value), for male patients (8-13) and for female patients (6-11).
If the patient’s treatment pressure is known, the minimum pressure can be set to P-2 (if less than the initial pressure, then set initial pressure as minimum pressure); the maximum pressure can be set to P+2. For example, if the titration pressure is 10, the pressure range can be set to: 8-12 cmH2O.

Common Use Failures:

Nasal/full mask has fallen off;
The patient is awaked by large air leakage, check the machine records of air leakage;
Feel dry in the morning;
Feel bloated in the morning.

Common Cause Analysis

Nasal/full mask has fallen off: caused by insufficient pressure or air leakage. The patient pulled off his mask because he was suffocating.
The patient is awakened by insufficient pressure or air leakage: the patient often has a rapid heartbeat due to suffocation.
Feel mouth dry in the morning： common reasons are insufficient pressure or air leakage, the mouth is dry due to the rapid flow of air from the mouth. There are also a few that are caused by insufficient humidification.
Dizziness after used machine few days：Many patients with hypertension or diabetes did not reduce or stop medicine, resulting in hypotension or hypoglycemia. Therefore, for these patients, daily monitoring of blood pressure and blood sugar is necessary. Follow physician’s advice to reduce or stop the medicine.
Feel bloated in the morning：The pressure is too high and the airflow enters the stomach.

Nasal/Full Face Mask Management

Too much air leakage

Air leakage in mouth area→ Use full face mask or lower jaw belt
Change mask size and headgear adjustment

Pharyngeal dryness

Constant temperature humidifier
Warming humidifier

Skin irritation/injury

Adjust nasal/full mask size and tightness
Use a softer mask
Intermittent use

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