From the Guidelines
BiPAP should be considered in patients with heart failure and respiratory distress, as it can help reduce the work of breathing, improve oxygenation, and decrease cardiac preload and afterload, as recommended by the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1.
Key Points
- BiPAP is a non-invasive ventilation therapy that delivers two levels of air pressure: higher pressure during inhalation and lower pressure during exhalation.
- It is beneficial for patients with pulmonary edema, as it helps push fluid out of the lungs and back into circulation.
- BiPAP is typically initiated in hospital settings under medical supervision, with settings individually tailored based on the patient's condition.
- Treatment duration varies from hours to days depending on clinical response.
- Common side effects include mask discomfort, skin irritation, and claustrophobia.
Recommendations
- Non-invasive positive pressure ventilation, including BiPAP, should be considered in patients with respiratory distress (respiratory rate >25 breaths/min, SpO2 <90%) and started as soon as possible to decrease respiratory distress and reduce the rate of mechanical endotracheal intubation 1.
- BiPAP can reduce blood pressure and should be used with caution in hypotensive patients, with regular monitoring of blood pressure 1.
Evidence
- The 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure recommend the use of non-invasive positive pressure ventilation, including BiPAP, in patients with respiratory distress 1.
- A study published in the Annals of Emergency Medicine in 2007 found that BiPAP was associated with a higher incidence of intubation, myocardial infarction, and the combined endpoint of death, need for mechanical ventilation, or myocardial infarction within 24 hours of admission, although the results were limited by differences in nitrate dosing between the two groups 1.
- Another study published in the same journal in 2007 found that BiPAP was no more efficacious than CPAP, and may have been associated with a higher rate of myocardial infarction, although the results were questionable due to selection bias and small sample size 1.
From the Research
Role of BiPAP in Heart Failure
- BiPAP (Bilevel Positive Airway Pressure) is a form of noninvasive ventilation that has been studied for its potential benefits in treating heart failure, particularly in acute decompensated heart failure and cardiogenic pulmonary edema 2, 3, 4, 5, 6.
- The use of BiPAP in heart failure has been shown to improve oxygenation, reduce the need for intubation, and decrease symptoms such as dyspnea 2, 4, 6.
- BiPAP has also been found to have hyperacute hemodynamic effects, including improvements in arterial blood oxygenation, hemodynamics, and microcirculation perfusion in patients with acute heart failure and left ventricular systolic dysfunction 3.
- In patients with exacerbation of congestive heart failure and functional mitral regurgitation, BiPAP has been shown to reduce mitral regurgitation and improve left ventricle ejection fraction 5.
- Noninvasive positive pressure ventilation, including BiPAP, is considered a first-line treatment for patients with acute decompensated heart failure and cardiogenic pulmonary edema, providing favorable physiologic benefits and improving clinical symptoms 6.
Key Findings
- A prospective, randomized trial found that BiPAP decreased the intubation rate and improved cardiopulmonary parameters in severe congestive heart failure patients compared to high flow oxygen by mask 2.
- A study on the hyperacute effects of BiPAP found significant improvements in hemodynamic, arterial blood gas, and microcirculation indexes in patients with acute heart failure and left ventricular systolic dysfunction 3.
- The use of BiPAP has been shown to increase oxygenation, improve hemodynamic stability, and decrease the need for intubation in patients with congestive heart failure 4.
- BiPAP has been found to be effective in reducing functional mitral regurgitation in patients with exacerbation of congestive heart failure 5.
- Noninvasive positive pressure ventilation, including BiPAP, is a recommended treatment for patients with acute decompensated heart failure and cardiogenic pulmonary edema, providing favorable physiologic benefits and improving clinical symptoms 6.