Non-Invasive Positive Pressure Ventilation: BiPAP vs CPAP

Introduction

• Non-Invasive Ventilation (NIV): Provides positive pressure ventilation without an artificial airway.
• Primary Goal: Avoid intubation and reduce complications associated with mechanical ventilation.
• Two Main Types:
  • BiPAP (Bi-level Positive Airway Pressure)
  • CPAP (Continuous Positive Airway Pressure)

General Concepts of Non-Invasive Ventilation

• Settings:
  • IPAP (Inspiratory Positive Airway Pressure): Pressure above zero during the inspiratory phase, similar to peak airway pressure in mechanical ventilation.
  • EPAP (Expiratory Positive Airway Pressure): Pressure above zero during the expiratory phase, similar to PEEP in mechanical ventilation.
• Common Indications:
  • Severe dyspnea
  • Acute respiratory failure
  • Acute exacerbation of COPD
  • Congestive heart failure, pulmonary edema
  • Avoid reintubation and obstructive sleep apnea
• Contraindications: Unstable or critically ill patients

CPAP (Continuous Positive Airway Pressure)

• Function: Positive pressure is maintained continuously during the breathing cycle.
• Indication: Primarily used for obstructive sleep apnea.
• Characteristics:
  • Must be breathing spontaneously
  • IPAP equals EPAP, providing continuous pressure
• Contraindications:
  • Apnea and hypoventilation
  • Respiratory muscle fatigue
  • Facial burns or trauma
  • Claustrophobia
• Monitoring: Look for signs of fatigue (dyspnea, tachycardia, increased PaCO2, increased respiratory rate).

BiPAP (Bi-level Positive Airway Pressure)

• Function: Provides two levels of pressure - IPAP and EPAP.
• Indications:
  • Acute respiratory failure
  • Acute exacerbation of COPD
  • Cardiogenic pulmonary edema
• Evaluation: Based on the patient's ABG results.
• Contraindications:
  • Apnea
  • Unmanageable secretions
  • Facial burns or trauma
  • Claustrophobia

Interfaces for BiPAP and CPAP

• Nasal Mask: Covers only the nose; common for CPAP in sleep apnea.
• Oral Nasal Mask: Covers mouth and nose; better seal than nasal mask but risks aspiration.
• Nasal Pillows: Prongs inserted into the nose; small and comfortable, but can cause nasal congestion.
• Full Face Mask: Covers entire face; used when other masks leak.

Titrating Non-Invasive Ventilation

• Adjustments: Based on patient's needs; start with IPAP/EPAP levels of 10/5 cm H2O.
• IPAP Range: 8-12 cm H2O.
• EPAP Range: 4-5 cm H2O.
• Adjustments: Made in 1-2 cm H2O increments.

Conclusion

• Understanding the functions, settings, and indications for BiPAP and CPAP helps in selecting appropriate therapy.
• For more information, resources are available on "Respiratory Therapy Zone" website.

Note: Ensure to monitor patients for potential issues and adjust settings according to their ventilatory and oxygenation status.