What are the contraindications for Bi-Level Positive Airway Pressure (BiPAP) therapy?

From the Guidelines

BiPAP therapy is contraindicated in patients with respiratory arrest, untreated pneumothorax, facial trauma or burns, recent facial or upper airway surgery, and inability to protect the airway, as these conditions may lead to increased morbidity, mortality, and decreased quality of life 1.

Key Contraindications

• Respiratory arrest
• Untreated pneumothorax
• Facial trauma or burns that prevent proper mask fitting
• Recent facial, esophageal, or gastric surgery
• Inability to protect the airway

Relative Contraindications

• Hemodynamic instability
• Agitated or uncooperative patients
• Excessive secretions
• Recent upper gastrointestinal surgery
• Nausea and vomiting
• Untreated severe obstructive sleep apnea

Special Considerations

• BiPAP should be used cautiously in patients with bullous lung disease, as positive pressure may increase the risk of pneumothorax 1.
• Patients with altered mental status may be at risk for aspiration, and BiPAP may be inappropriate unless they can adequately protect their airway 1.
• Clinicians should assess the patient's ability to remove the mask independently in case of vomiting or respiratory distress, as well as their overall clinical condition and respiratory status to determine if more invasive ventilation is needed 1.

From the Research

Contraindications in BiPAP

• The provided studies do not directly address contraindications in BiPAP, but rather its efficacy and safety in various patient populations 2, 3, 4, 5, 6.
• However, it can be inferred that BiPAP may be contraindicated in patients who are not cooperative or hemodynamically stable, as these patients were excluded from the studies 4.
• Additionally, BiPAP may be contraindicated in patients with certain conditions, such as:
  • Severe respiratory acidosis or hypercapnia that requires immediate intubation 5.
  • Cardiac arrest or severe cardiac instability 4.
  • Severe pneumonia or acute respiratory distress syndrome (ARDS) that requires invasive mechanical ventilation 6.
• It is essential to note that the decision to use BiPAP should be made on a case-by-case basis, taking into account the individual patient's condition, medical history, and response to treatment 2, 3, 4, 5, 6.
• The studies suggest that BiPAP can be a useful treatment option for patients with acute hypercapnic respiratory failure, including those with COPD and non-COPD etiologies 2, 3, 5, 6.
• However, the lack of direct evidence on contraindications highlights the need for further research and clinical guidelines to inform the safe and effective use of BiPAP in various patient populations 2, 3, 4, 5, 6.