From the Guidelines
BiPAP is indicated for patients with acute respiratory failure, particularly those with COPD who develop acute respiratory acidosis, and should be considered when the pH is ≤7.35, PaCO2 is >45 mmHg, and the respiratory rate is >20-24 breaths·min-1 despite standard medical therapy. The use of BiPAP in clinical practice is guided by specific criteria, including the patient's respiratory rate, blood gas measurements, and underlying condition 1. Some key points to consider when using BiPAP include:
- The patient's pH level, with no lower limit below which a trial of NIV is inappropriate, but a greater risk of failure with lower pH levels 1
- The importance of close monitoring, particularly in patients with severe respiratory acidosis, to ensure rapid access to endotracheal intubation and invasive ventilation if needed 1
- The preference for BiPAP in patients with COPD who develop acute respiratory acidosis during hospital admission 1 The implementation of BiPAP should be based on the latest clinical practice guidelines, such as those published in the European Respiratory Journal 1, to ensure the best possible outcomes for patients with acute respiratory failure. Key considerations for BiPAP use include:
- Patient selection, based on factors such as respiratory rate, blood gas measurements, and underlying condition
- Close monitoring of patient response to BiPAP therapy, including respiratory rate, oxygen saturation, and patient comfort
- The potential need for rapid access to endotracheal intubation and invasive ventilation in patients who do not improve with BiPAP therapy 1.
From the Research
Indications for BIPAP
The following are indications for BIPAP:
- Acute hypercapnic respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD) 2, 3, 4
- Acute hypercapnic respiratory failure due to etiologies other than COPD, such as acute cardiogenic pulmonary edema (ACPO) and solid tumors 5
- Acute respiratory failure (ARF) in patients who are hemodynamically stable and have preserved spontaneous breathing 6
- Type II respiratory failure due to acute exacerbation of COPD 3
- Non-COPD acute hypercapnic respiratory failure patients, although the effectiveness of BiPAP in this population is still unclear 5
Benefits of BIPAP
The benefits of BIPAP include:
- Improved gas exchange 4, 6
- Avoidance of complications caused by endotracheal intubation 6
- Ability for patients to talk and take medications orally 6
- Reduced risk of mortality and need for endotracheal intubation in patients with acute hypercapnic respiratory failure due to acute exacerbation of COPD 4
- Reduced length of hospital stay and incidence of complications in patients with acute hypercapnic respiratory failure due to acute exacerbation of COPD 4