CPAP and Nebulized Meds

[ThadeusJ]

I have searched a few patient care protocols for information but I would like to get an idea on a wider scale. For those who use CPAP, what is the occurrence of administering nebulized bronchodilators at the same time? And for those who do, is it part of the same protocol or are you using two patient care protocols side by each (as they say), one for CPAP and another for other respiratory concerns?

 

[cprted]

If they're bronchospastic we can give Salbutamol and Atrovent through the CPAP, either by neb or MDI.

This is what our guidelines have to say about CPAP use:

Continuous Positive Airway Pressure (CPAP) - Does not replace bronchodilator (salbutamol/ventolin)therapy. If the patient is experiencing signs of bronchoconstriction, expiratory wheeze, increased inspiratory/expiratory ratio and accessory muscle use then bronchodilators should be initiated as per conventional practice. Follow indications and contraindications for CPAP use. PCPs must obtain an order from EPOS for CPAP. The majority of patients will respond to bronchodilators and CPAP simply will not be required. However CPAP use may be appropriate in asthmatics or patients with COPD who do not respond to initial doses of bronchodilators. Both multi dose inhalers (MDI) and nebulized brochodilators may be given in conjunction with CPAP. Nebulized medication may be given concurrently with CPAP through the addition of a T-piece and nebulizer placed in-line with the CPAP device (see CPAP procedural guideline).

 

[DesertMedic66]

Our protocol states we may use it with an in-line ventilatory device so either CPAP or BVM. All of our CPAPs come with an adapter inside the sealed bag to connect a nebulizer.

 

[NomadicMedic]

Almost every time.

 

[sirengirl]

Our COPD/Asthma protocol has a caveat in it for CPAP+duo neb. We carry the little blue T valve adapters which can be placed in-between the mask and the PEEP gauge. Happily we have just transitioned to the Flow-Safe CPAPs and they are awesome. Unhappily our medical director does not believe in prehospital steroids.

 

[GirevikMedic]

Where I'm at, and have been, CPAP is used simply as another O2 delivery method when warranted whether CHF/pulmonary edema or COPD/bronchospasm. In either case, you treat CHF/COPD as indicated normally. In moderate distress, CPAP enters the picture as a 'consideration'; meaning you can either put it on or leave it, it's up to you based on patient presentation and your discretion. If in severe distress, now it's CPAP time no questions asked. However, it does come with the standard contraindications still: vomiting, ALOC, hypotensive, can't protect own airway, ineffective breathing, etc. In regards to frequency of bronchodilators in conjunction with CPAP... about 50/50ish. I haven't had to break it out too often, though, myself.