Can BIPAP (Bilevel Positive Airway Pressure) help manage respiratory acidosis due to pneumonia?

From the Guidelines

BIPAP can be an effective treatment for managing respiratory acidosis due to pneumonia, as it helps reduce respiratory distress and improve gas exchange. The use of non-invasive positive pressure ventilation, such as BIPAP, is recommended in patients with respiratory distress, including those with pneumonia, as it can decrease the rate of mechanical endotracheal intubation 1. BIPAP delivers two levels of positive airway pressure, which assists breathing and improves gas exchange in patients with respiratory compromise. For pneumonia-induced respiratory acidosis, BIPAP can help reduce the work of breathing, improve alveolar ventilation, and enhance carbon dioxide elimination, directly addressing the underlying cause of respiratory acidosis. Some key considerations for using BIPAP in this context include:

• Monitoring of transcutaneous arterial oxygen saturation (SpO2) and measurement of blood pH and carbon dioxide tension 1
• Initial BIPAP settings may include an IPAP of 10-14 cmH2O and EPAP of 4-6 cmH2O, with adjustments based on patient response and arterial blood gas measurements
• Oxygen supplementation is typically added to maintain oxygen saturation above 92%
• Close monitoring is essential, and if the patient's condition deteriorates or they fail to improve within 1-2 hours, endotracheal intubation and mechanical ventilation may be necessary 1. It's also important to note that non-invasive positive pressure ventilation can reduce blood pressure and should be used with caution in hypotensive patients, with regular monitoring of blood pressure 1.

From the Research

Respiratory Acidosis from Pneumonia and BIPAP

• Respiratory acidosis is a condition characterized by an increase in arterial partial pressure of carbon dioxide, which can occur due to various factors including pneumonia 2.
• Pneumonia can lead to respiratory acidosis by causing inflammation and damage to the lung tissue, leading to impaired gas exchange and increased carbon dioxide levels in the blood.
• BIPAP (Bilevel Positive Airway Pressure) is a type of non-invasive ventilatory support that can help manage respiratory acidosis by providing two different levels of air pressure, one for inhalation and one for exhalation 3.

Effectiveness of BIPAP in Managing Respiratory Acidosis

• Studies have shown that BIPAP can be effective in managing respiratory acidosis in patients with pneumonia, by improving gas exchange and reducing the need for invasive mechanical ventilation 4.
• BIPAP has been shown to be simple, safe, and well-tolerated by patients, and can help reduce the length of stay in the hospital 4.
• However, the effectiveness of BIPAP in managing respiratory acidosis due to pneumonia may depend on various factors, including the severity of the condition and the underlying cause of the pneumonia.

Comparison with Other Treatments

• Other treatments for respiratory acidosis due to pneumonia may include invasive mechanical ventilation, corticosteroids, and sodium bicarbonate therapy 5, 6.
• However, the use of sodium bicarbonate therapy for respiratory acidosis is controversial, and there is limited evidence to support its effectiveness 6.
• Corticosteroids may be beneficial in reducing inflammation and improving outcomes in patients with severe community-acquired pneumonia, but their effectiveness in managing respiratory acidosis is not well established 5.