7 - BiPAP

ramp

slow increase of IPAP and EPAP over time to increase patient comfort and decrease time to fall asleep

indications for BiPAP

• nocturnal hypoventilation (sleep apnea)

• NIV

• respiratory distress with dyspnea

• pH < 7.35 with P_aCO₂ > 45

• RR > 25

• having breathing difficulty but stable

• can breathe spontaneously

• refractory hypoxemia with normal ventilation

• NMD, restriction, ventilatory insufficiency

contraindications for BiPAP

• absolute

  • untreated severe pneumothorax

• relative

  • hypovolemia

  • ↑ICP

  • unilateral lung disease

  • pulmonary hyperinflation

  • nasal BiPAP: recent lung/sinus surgery

  • claustrophobia

adjusting BiPAP parameters

• general settings

  • IPAP 8 (10)

  • EPAP 3 (5)

  • i-time% 33%

• IPAP increase in 2’s → increased ventilation and ↓CO₂

• EPAP increase in 2’s → increased oxygenation and ↑O₂

how to minimize CO₂ rebreathing in BiPAP

• ↑EPAP

• ↑leak

• fixed leak in mask

• titrate O₂ into mask

humidity for BiPAP

• may be needed for patient comfort

• only use devices recommended by manufacturer

BiPAP monitoring

• direct

  • RR

  • MAP

  • IPAP

  • EPAP

• indirect

  • V_T

  • V_E

  • leak