From the Guidelines
BiPAP is indicated for patients with acute heart failure and respiratory distress, characterized by a respiratory rate >25 breaths/min and SpO2 <90%, as it can decrease respiratory distress and reduce the rate of mechanical endotracheal intubation 1. The primary indications for BiPAP include:
- Acute or chronic respiratory failure with hypercapnia, particularly in COPD exacerbations where patients demonstrate respiratory acidosis
- Acute cardiogenic pulmonary edema
- Sleep apnea, particularly central sleep apnea or complex sleep apnea
- Neuromuscular disorders affecting respiratory function
- As a weaning strategy for patients coming off mechanical ventilation For implementation, BiPAP typically starts with an inspiratory positive airway pressure (IPAP) of 8-12 cmH2O and expiratory positive airway pressure (EPAP) of 3-5 cmH2O, with adjustments based on patient response and arterial blood gas measurements, as recommended by the American Academy of Sleep Medicine 1. The pressure gradient between IPAP and EPAP (usually 5-10 cmH2O) provides ventilatory support by reducing work of breathing, making BiPAP effective for patients who need respiratory support but can still breathe spontaneously. It is essential to monitor patients closely while on BiPAP, especially in those with hypotension, as non-invasive positive pressure ventilation can reduce blood pressure 1. In patients with COVID-19, BiPAP may be considered for those with hypoxemic respiratory failure, but its use should be closely monitored to prevent delays in intubation 1.
From the Research
Indications for BiPAP
The following are indications for BiPAP (bilevel positive airway pressure) ventilation:
- Acute hypercapnic respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease (COPD) 2, 3
- Acute respiratory failure in patients with COPD who have failed usual medical care 3
- Weaning COPD patients from invasive mechanical ventilation (IMV) 3
- Treatment of acute hypercapnic respiratory failure in non-COPD patients, such as those with acute cardiogenic pulmonary edema (ACPO) 4
- Chronic respiratory failure in stable COPD patients 5, 6
Benefits of BiPAP
The benefits of BiPAP ventilation include:
- Reduced need for endotracheal intubation 3
- Reduced inhospital mortality 3
- Reduced length of hospital stay 3
- Improved gas exchange and sleep quality 5, 6
- Reduced work of breathing and improved exercise tolerance 6
- Improved health-related quality of life 6
Patient Selection
BiPAP ventilation is typically used in patients with: