From the Guidelines
The majority of well-informed adult patients with obstructive sleep apnea (OSA) should be initiated on CPAP or APAP over BiPAP due to similar benefits and lower costs, unless specific conditions such as high pressure requirements or intolerance to CPAP/APAP are present. When deciding between BiPAP and CPAP, it's essential to consider the patient's respiratory condition, comfort needs, and therapeutic goals. BiPAP is typically indicated for patients who require respiratory assistance with both inhalation and exhalation, such as those with COPD, neuromuscular disorders, obesity hypoventilation syndrome, or central sleep apnea 1. Some key points to consider when choosing between BiPAP and CPAP include:
- BiPAP provides two different pressure levels, higher during inhalation (IPAP) and lower during exhalation (EPAP), which can make breathing more comfortable for patients with difficulty exhaling against constant pressure 1.
- Patients with hypercapnia (elevated CO2 levels) may benefit from BiPAP as it provides better ventilatory support.
- Initial BiPAP settings typically start with an IPAP of 8-12 cmH2O and EPAP of 3-5 cmH2O, with adjustments based on patient response and arterial blood gas measurements.
- The decision between BiPAP and CPAP should be made after thorough assessment of the patient's respiratory condition, comfort needs, and therapeutic goals, taking into account the potential benefits and harms of each device, as well as the patient's individual needs and preferences 1.
From the Research
Criteria for BiPAP versus CPAP
The decision to use BiPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure) depends on various factors, including the patient's condition and the specific clinical setting.
- BiPAP is commonly used to treat patients with acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD) 2.
- CPAP is often used to treat obstructive sleep apnea (OSA) and may be effective in patients with obesity-related respiratory failure 3.
- The use of BiPAP or CPAP should be based on individual patient needs and clinical judgment, as there is no single therapy that is suitable for all patients 3.
- In patients with acute cardiogenic pulmonary edema, BiPAP and CPAP appear to have similar efficacy in reducing the rates of endotracheal intubation and mortality 4.
Clinical Settings
The choice between BiPAP and CPAP may also depend on the clinical setting, such as:
- Intensive care unit (ICU) or ward setting: BiPAP can be effective in both settings for patients with acute hypercapnic respiratory failure due to COPD exacerbation 2.
- Emergency and ward areas of acute hospitals: Non-invasive ventilation, including BiPAP, can be used to manage acute type 2 respiratory failure in COPD patients 5.
Patient-Specific Factors
Patient-specific factors, such as:
- Severity of respiratory failure: BiPAP may be more effective in patients with severe respiratory failure 2.
- Presence of comorbidities: Patients with obesity-related respiratory failure may benefit from CPAP or BiPAP 3.
- Tolerance to therapy: Patients who are intolerant to one form of therapy may benefit from the other 2.