From the Guidelines
BiPAP is indicated for patients with acute heart failure, chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome, and sleep apnea that doesn't respond to CPAP, as well as those with neuromuscular disorders or chest wall deformities, according to the most recent guidelines 1. The primary goal of BiPAP is to provide breathing support while reducing the work of breathing and maintaining airway patency.
- BiPAP is particularly beneficial for patients with hypercapnic respiratory failure, with a pH between 7.25-7.35, or those with significant work of breathing who are not candidates for intubation.
- Typical initial BiPAP settings include an inspiratory pressure (IPAP) of 8-12 cmH2O and an expiratory pressure (EPAP) of 3-5 cmH2O, which can be titrated based on patient response, oxygen saturation, and arterial blood gases 1.
- The use of BiPAP should be considered in patients with respiratory distress, defined as a respiratory rate >25 breaths/min and SpO2 <90%, and should be started as soon as possible to decrease respiratory distress and reduce the rate of mechanical endotracheal intubation 1.
- It's essential to monitor patients on BiPAP closely, especially those with hypotension, as non-invasive positive pressure ventilation can reduce blood pressure 1.
- BiPAP is not recommended for patients with severe hypoxemia, hemodynamic instability, or those unable to protect their airway, as these patients may require intubation instead.
- The most recent guidelines from the European Society of Cardiology (2016) support the use of BiPAP in patients with acute heart failure, emphasizing the importance of monitoring and adjusting treatment based on patient response 1.
From the Research
BIPAP Indications
- BIPAP (Bi-level Positive Airway Pressure) is used to treat type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD) 2
- It is also used for patients with chronic hypercapnic respiratory failure, including those with COPD, obesity hypoventilation syndrome (OHS), and other conditions 3, 4, 5
- The use of BIPAP has been shown to improve dyspnea and gas exchange, avoid the need for intubation, and reduce morbidity and mortality rates in patients with COPD 3
- BIPAP can be used in various settings, including acute care, postoperative care, and home care, for patients with COPD and other conditions 3, 5
Specific Conditions Treated with BIPAP
- Acute hypercapnic respiratory failure due to COPD exacerbation 2
- Chronic hypercapnic respiratory failure due to COPD 4, 5
- Obesity hypoventilation syndrome (OHS) 5
- Neuromuscular disease (NMD) and chest wall disease (CWD) 5
- Postoperative respiratory failure in patients with COPD 3