Can a patient with a history of takotsubo disease, celiac disease, hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), renal cell carcinoma with right nephrectomy, and obstructive sleep apnea (OSA) using BiPap (bilevel positive airway pressure) at night with settings from 6 to 45, obtain orders for BiPap?

From the Guidelines

The patient should receive orders for BiPAP therapy during her hospital stay, with settings of IPAP 6 cmH2O and EPAP 45 cmH2O, as per her home regimen, to maintain continuity of care and prevent potential complications from obstructive sleep apnea. According to the American Academy of Sleep Medicine clinical practice guideline 1, BiPAP is defined as a respiratory assist device that delivers inspiratory and expiratory positive airway pressure, and its use should be based on the clinician's clinical judgement and the individual patient's needs. The patient's history of obstructive sleep apnea, as well as her multiple comorbidities, including takotsubo disease, hypertension, diabetes, chronic kidney disease, and history of renal cell carcinoma, make it essential to continue her home BiPAP regimen during her hospital stay.

Some key points to consider in this patient's care include:

• The importance of maintaining her home BiPAP schedule and settings to prevent sleep apnea complications, especially post-operatively 1
• The potential risks of interrupting BiPAP therapy, including oxygen desaturation, increased risk of respiratory complications, and potentially impacting her recovery from shoulder surgery
• The need for consultation with the respiratory therapy department to ensure the appropriate BiPAP machine is available and properly set up according to her home settings
• The consideration of additional strategies to maximize the patient's comfort and adherence to BiPAP therapy, such as educational interventions, behavioral interventions, and troubleshooting interventions 1

Overall, continuing the patient's home BiPAP regimen during her hospital stay is crucial to maintaining her respiratory support and preventing potential complications from obstructive sleep apnea, particularly in the context of her multiple comorbidities and recent surgery.

From the Research

Patient's Request for BiPAP Orders

The patient is requesting orders for BiPAP, reporting settings of "from 6 to 45." To determine if the patient can get orders for BiPAP, we need to consider their medical history and current condition.

• The patient has a history of takotsubo disease, celiac disease, HTN, DM, CKD, renal cell CA with R nephrectomy, and OSA, for which they use BiPAP at night.
• The patient's current condition is post-operative, having undergone a right shoulder ORIF.

Relevant Studies

There are studies that discuss the use of BiPAP in various medical conditions, but none directly address the patient's specific situation.

• A study on non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS found that non-invasive strategies appear safe and effective in mild-to-moderate hypoxemia 2.
• A study on bi-level positive airway pressure (BiPAP) and acute cardiogenic pulmonary oedema (ACPO) in the emergency department discussed the potential benefits and limitations of using BiPAP in acute respiratory failure, but did not provide conclusive evidence for its use in this patient's condition 3.
• A study on positional variations in fracture toughness, stiffness, and strength of descending thoracic pig aorta is not relevant to the patient's request for BiPAP orders 4.

Ability to Get Orders for BiPAP

Based on the provided studies, there is no direct evidence to support or deny the patient's request for BiPAP orders. The patient's medical history and current condition should be taken into consideration when making a decision about BiPAP orders, and consultation with a healthcare professional is necessary to determine the best course of action.