what's up guys in this video we are going to talk about a non-invasive positive pressure ventilation and more specifically the difference between BiPAP and CPAP are you ready let's go non-invasive ventilation is a method of providing positive pressure ventilation without the use of an artificial airway the primary goal of non-invasive ventilation is to avoid intubation with non-invasive ventilation since there's no artificial airway this reduces some of the complications that are associated with conventional mechanical ventilation there are two primary types of non-invasive ventilation BiPAP and CPAP and that's what we're going to cover in this video but before we get into the differences between the two there are a few things in general that you need to know about non-invasive positive pressure ventilation first let's talk about the settings in non-invasive ventilation there are two primary settings I pup and a pap pap stands for inspiratory positive airway pressure this is an airway pressure that is above zero during the inspiratory phase of breathing it works similar to the peaks airway pressure in traditional mechanical ventilation so if you increase the IPOP setting this will increase the delivered tidal volume and then you have the e pap which stands for expert Ori positive airway pressure and this is an airway pressure that is above zero during the you guessed it expert or e phase of breathing it works similar to peep in traditional mechanical ventilation or CPAP during spontaneous breathing increasing the evap setting improves the patient's oxygenation by increasing the functional residual capacity so essentially you can make adjustments to the iPad and epub settings depending on the patient's ventilatory and oxygenation status some of the common indications for non-invasive ventilation include severe dyspnea acute respiratory failure acute exacerbation of COPD congestive heart failure pulmonary edema adn I order or do not intubate to avoid reintubation of a patient who was recently extubated and obstructive sleep apnea keep in mind that non-invasive ventilation should not be used on patients who are unstable or critically ill [Music] well now that we've covered the basics first and foremost let's talk about CPAP which stands for continuous positive airway pressure CPAP is when positive pressure is delivered and maintained throughout the entire breathing cycle it's important to remember that CPAP can only be delivered if the patient is breathing spontaneously because it does not include any mechanical breaths since it's a continuous pressure CPAP is active when the IPOP setting is equal to the e PAP setting because if you think about it this would make the inspiratory pressure equal to the X betwee pressure which means that a continuous pressure is being delivered ie the name continuous positive airway pressure the primary and most common indication for CPAP is obstructive sleep apnea and if you're not familiar obstructive sleep apnea is a condition where the patient has five episodes of apnea that last at least 10 seconds each within a one hour time period while asleep this type of sleep apnea is caused by an airflow obstruction that occurs along with continuous breathing efforts by the patient will focus more on sleep apnea in another video but for now just know that patients can wear a CPAP mask at night while asleep and the continuous positive airway pressure that is applied helps to decrease the apnea episodes by keeping the airway open to overcome the obstruction CPAP isn't always recommended there are some contraindications for CPAP and they are apnea and hypoventilation because remember the patient has to be breathing spontaneously and more contraindications include respiratory muscle fatigue facial burns or trauma because if there's burns or trauma to the face the mask is probably going to be too uncomfortable for the patient and they're not going to be able to tolerate it and claustrophobia because if the patient's claustrophobic even though the mask is actually helping the patient to them it's going to feel like it's suffocating them so they're probably not going to tolerate it cpap is a spontaneous breathing mode in traditional mechanical ventilation as well and it's commonly used along with pressure support during weaning in this video we're focusing specifically on non-invasive ventilation but there are just a few things I want to touch on really quick when the CPAP mode is in use the patient must be monitored carefully for fatigue because the patient is the one that is providing all of the minute ventilation meaning that they are the ones that are doing most of the work so for example some signs of fatigue include dis Nia tachycardia an increasing PA co2 level and increasing respiratory rate a decreasing tidal volume or vital capacity and a decreasing maximum inspiratory pressure in such a case you would most likely be able to tell that the patient is working harder than normal to breathe and you probably notice some usage of the accessory muscles of ventilation when these signs are present the patient should be switched from CPAP to a conventional mode of ventilation now switching gears just a bit let's talk about by palp which stands for bi-level positive airway pressure earlier we discussed how CPAP only has one continuous pressure BiPAP on the other hand has two levels of pressure hence the name by level we already mentioned them earlier but the two pressures are I pap and a pap I pap is what controls the tidal volume that is delivered epad functions as peep there are two primary indications for BiPAP and they are acute respiratory failure and an acute exacerbation of COPD and the best way to determine if by pap is indicated is to look at the patient's ABG results just to give a very simple example if a patient has a decreased pH and an increased paco2 you could recognize that ventilatory issues are present and BiPAP would be indicated cardiogenic pulmonary edema is another common indication for BiPAP and it's been shown to decrease the need for traditional mechanical ventilation in these patients like CPAP BiPAP isn't recommended for everyone and there are some contraindications for example apnea unmanageable secretions facial burns or trauma and claustrophobia now let's talk about the interfaces for BiPAP and CPAP these are just the different types of mess that the patient can wear in order to receive this type of therapy first we have the nasal mask which covers only the nose it's the most common mask worn with CPAP in patients with sleep apnea and is typically tolerated well by most patients since the mouth isn't covered the biggest problem with this interface is leakage through the mouth for mouth breathers it can also cause nasal dryness and nasal drainage in some cases then there is the oral nasal mask which covers both the mouth and the nose but otherwise it functions basically the same as the nasal mask but since the mouth is covered this one provides a better seal and leakage isn't as big of a problem however aspiration and regurgitation can be potential problems with this interface and another potential problem is as fixation if the machine electricity or gas source work to fill but not to worry most masks have safety valves to prevent this from occurring next we have the nasal pillows these are prongs that are inserted into the nose this one resembles the nasal mask but is much smaller this is a common interface in CPAP therapy and would not be recommended for BiPAP since this is the smallest interface it's typically the most comfortable as well for most patients however some complications include nasal congestion dry mouth and nose bleeds as with the nasal mask gas leakage through the mouth is also a potential problem and last but not least you have the full face mask which covers basically the entire face it's the largest interface which means it's also most uncomfortable for most patients this one can be used when other masks have been tried but there was a lot of leakage because since this one covers the mouth nose an entire face it can have prevent a lot of the leaks that occur with the other interfaces and the last thing we want to cover is titrating non-invasive positive pressure ventilation in other words when it's appropriate to make changes to the settings when non-invasive ventilation is used to provide ventilatory support for patients the iPad and eep app levels can be adjusted depending on the patient's needs being very general here a good starting point is 10 over 5 or an iPad settings level of 10 and an EEP app settings level of 5 like I said this is not always the case this is just a very general example but the appropriate initial pressure setting for iPad can range from 8 to 12 centimeters of water pressure the appropriate initial pressure level for a pap should range from 4 to 5 centimeters of water pressure the iPad and a pap settings can be adjusted in increments of 1 to 2 centimeters of water pressure depending on the needs of the patient for example if the patient needs a larger tidal volume to try to decrease the paco2 value in order to blow off some of that co2 you would want to increase the iPad setting or another example to improve the patient's oxygenation you would want to increase the epub setting which essentially is the same thing as increasing the level of peep so there you have it now you know pretty much everything there is to know about non-invasive ventilation and hopefully you now have a better understanding of BiPAP and CPAP including their similarities their differences and when you would and would not want to recommend each type of therapy if you thought this video was helpful do me a favor and hit that like button if you want to support the channel I know I asked in every video but it really helps and I really do appreciate it and while you're here you might as well subscribe because we have some really good videos coming out soon and I would hate for you to miss them and if you want to check out our full guide on non-invasive ventilation just go to our website at respiratory therapy zone comm or to make it easy I'll just drop a link down below in the description and that's it for this one thanks again for watching and I will see you in the next video and as always breathe easy my friend [Music]