From the Guidelines
BiPAP therapy is contraindicated in patients with untreated pneumothorax, as the positive pressure can expand the air leak and worsen respiratory compromise, and it should be withheld from patients with pneumothorax as long as the pneumothorax is present, as recommended by the study published in the American Journal of Respiratory and Critical Care Medicine in 2010 1. The use of BiPAP is also contraindicated in several other conditions, including:
- Facial trauma, recent facial, upper airway, or esophageal surgery, as the mask interface may cause pain or disrupt surgical repairs 1
- Impaired consciousness, as patients who cannot protect their airway are at risk of aspiration 1
- Severe hemodynamic instability, uncontrolled vomiting, or copious respiratory secretions, as these conditions can be exacerbated by the positive pressure delivered by BiPAP 1
- Bullous lung disease, where positive pressure could rupture bullae 1
- Respiratory arrest and cardiac arrest, which require more invasive ventilatory support 1 These contraindications exist because BiPAP delivers positive pressure that can exacerbate certain conditions, and requires patient cooperation and a stable enough clinical picture to be used safely and effectively. It is worth noting that while there are several contraindications to BiPAP therapy, the most recent and highest quality study, published in 2010, specifically addresses the use of BiPAP in patients with pneumothorax, and recommends withholding BiPAP from these patients as long as the pneumothorax is present 1.
From the Research
Contraindications for BiPAP
- The provided studies do not explicitly list contraindications for BiPAP (Bilevel Positive Airway Pressure) 2, 3, 4, 5, 6.
- However, it can be inferred that BiPAP, a form of non-invasive ventilation, may not be suitable for patients who require immediate intubation or have severe respiratory failure 3, 4.
- Patients with moderate-to-severe hypoxemia (PaO2/FiO2 ≤ 150 mmHg) may also not be ideal candidates for BiPAP as first-line treatment, as it can lead to delayed intubation and increased mortality 3.
- Additionally, BiPAP may not be recommended for patients who are unable to protect their airway or have a high risk of aspiration [no direct evidence from the provided studies].
- It is essential to note that the decision to use BiPAP or any other form of ventilation should be made on a case-by-case basis, taking into account the individual patient's condition and medical history 5, 6.