From the Guidelines
BiPAP therapy should be considered in patients with heart failure and respiratory distress, particularly those with pulmonary edema or sleep-disordered breathing, as it can help reduce respiratory distress and improve oxygenation and ventilation. The use of BiPAP in heart failure patients is supported by the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure, which recommend non-invasive positive pressure ventilation (including BiPAP) in patients with respiratory distress and a respiratory rate >25 breaths/min, SpO2 <90% 1.
Key Considerations
- BiPAP works by reducing both preload and afterload on the heart while improving oxygenation and ventilation.
- Typical initial settings include an inspiratory positive airway pressure (IPAP) of 10-12 cmH2O and expiratory positive airway pressure (EPAP) of 4-5 cmH2O, which can be titrated upward as needed based on patient response.
- BiPAP should be used alongside standard heart failure treatments, including diuretics, vasodilators, and other appropriate cardiac medications.
- Continuous monitoring of oxygen saturation, respiratory rate, and work of breathing is essential during BiPAP therapy.
Benefits and Risks
- Benefits: reduced respiratory distress, improved oxygenation and ventilation, decreased work of breathing, and improved cardiac function.
- Risks: potential for decreased blood pressure, require careful monitoring and adjustment of settings to minimize risks.
Long-term Use
- For patients with chronic heart failure and central sleep apnea, nightly BiPAP therapy may be beneficial as a long-term treatment to improve symptoms and potentially reduce hospitalizations.
The most recent and highest quality study supporting the use of BiPAP in heart failure patients is the 2016 ESC guidelines 1, which provides a comprehensive review of the evidence and recommendations for the use of BiPAP in heart failure patients.
From the Research
Bipap and Heart Failure
- Non-invasive mechanical ventilation (NIMV) therapy, including BiPAP, has been shown to improve left ventricular functions and reduce intubation rate and short-term mortality in patients with acute heart failure (HF) 2.
- BiPAP is one of the modes of NIMV used in the treatment of HF, along with Continuous Positive Airway Pressure (CPAP) and Adaptive Servo-Ventilation (ASV) 2.
- Noninvasive ventilation (NIV) has been found to rapidly improve respiratory distress and reduce the need for intubation and mortality in patients with acute cardiogenic pulmonary edema (ACPE) 3.
- BiPAP has theoretical advantages over CPAP, but its safety in a setting of heart failure has been questioned, and proper patient selection, close monitoring, and proper application of the technology are key to its success 4.
- The use of BiPAP in patients with acute heart failure and left ventricular systolic dysfunction has been shown to rapidly improve hemodynamic, arterial blood gas, and microcirculation indexes 5.
- Non-invasive ventilation, including BiPAP, is indicated in patients with acute heart failure associated with pulmonary disease and may be considered in some patients with cardiogenic shock after stabilization 6.
Benefits of BiPAP in Heart Failure
- Improves left ventricular functions 2
- Reduces intubation rate and short-term mortality in patients with acute heart failure 2
- Rapidly improves respiratory distress and reduces the need for intubation and mortality in patients with ACPE 3
- Improves hemodynamic, arterial blood gas, and microcirculation indexes in patients with acute heart failure and left ventricular systolic dysfunction 5