From the Guidelines
BiPAP therapy should be used with caution and under the guidance of a healthcare professional, with careful consideration of contraindications and proper fitting of the mask to ensure effective treatment and minimize adverse effects. To use a BiPAP, first ensure you have a properly fitted mask that creates a good seal without excessive leakage. Position yourself comfortably, typically with your head slightly elevated. Turn on the machine and allow it to reach the prescribed pressure settings before applying the mask to your face. Secure the mask with the headgear, ensuring it's snug but not overly tight. Breathe normally through your nose (or mouth and nose depending on mask type) and try to relax. The machine will sense your breathing pattern and provide appropriate pressure support. Some key points to consider when using BiPAP include:
- Ensuring the mask is properly fitted to prevent leakage and ensure effective treatment 1
- Starting with a minimum pressure of 4 cm H2O for CPAP and 8 cm H2O and 4 cm H2O for IPAP and EPAP, respectively, for BPAP 1
- Gradually increasing the pressure as needed to eliminate obstructive respiratory events, with a maximum pressure of 15 cm H2O for CPAP 1
- Considering alternative therapies, such as weight loss, positional therapy, or oral appliance therapy, for patients who cannot tolerate BiPAP or have contraindications 1
- Providing educational and behavioral interventions to improve adherence to BiPAP therapy, including troubleshooting and telemonitoring interventions 1 Common contraindications for BiPAP include:
- Untreated pneumothorax
- Recent facial or skull trauma or surgery
- Inability to protect the airway
- Excessive secretions
- Hemodynamic instability
- Severe nausea or vomiting
- Altered mental status, unless closely monitored BiPAP works by keeping airways open through positive pressure, reducing the work of breathing, improving gas exchange, and preventing alveolar collapse, making it effective for conditions like COPD exacerbations, sleep apnea, and heart failure with respiratory distress 1.
From the Research
Guidelines for Using BiPAP
- BiPAP is used to treat patients with sleep-related breathing disorders, including obstructive sleep apnea (OSA) 2.
- A diagnosis of OSA must be established by an acceptable method before using BiPAP 2.
- BiPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia 2.
- BiPAP can help augment ventilation via pressure support and may be used in patients who are poorly compliant with CPAP therapy 3.
Contraindications for BiPAP
- There is no specific evidence on absolute contraindications for BiPAP, but it is essential to follow clinical guidelines and consult with a healthcare professional before using BiPAP 2, 3.
- Patients with certain medical conditions, such as chronic obstructive pulmonary disease (COPD) or severe obesity, may require special consideration when using BiPAP 3, 4.
Usage and Titration
- Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure 2.
- Split-night, diagnostic-titration studies are usually adequate, but may not be suitable for all patients 2.
- The expiratory positive airway pressure (EPAP) should be set to suppress obstructive respiratory events, and the inspiratory positive airway pressure (IPAP) should be dynamically adjusted to range between 0 and 15 cm H2O above the EPAP 4.
Safety and Efficacy
- BiPAP therapy is safe, and side effects and adverse events are mainly minor and reversible 2.
- BiPAP can effectively suppress central sleep apnea in men with heart failure 4.
- The efficacy of BiPAP in treating OSA and other sleep-related breathing disorders has been demonstrated in several studies 2, 3, 5.