bilevel positive airway pressure (BiPAP)
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Indications
- acute respiratory failure (1st line)[12]
- reduces need for endotracheal intubation
- relative to endotracheal intubation
- reduces mortality
- does not improve neurologic status
- chronic hypercapneic respiratory failure[2][4]
- heart failure & cardiogenic pulmonary edema[5][6]
- more effective than CPAP alone[5]
- reduces the risk of endotracheal intubation & death
- does not protect against a new myocardial infarction.
- no data that CPAP reduces stroke reduces need for balloon pump or coronary revascularization[11]
- sleep-related hypoventilation syndromes
- end-stage respiratory failure due to neuromuscular disease
- complex sleep apnea[9]
- efficacy of BiPAP relative to CPAP for routine treatment of obstructive sleep apnea has not been established[2]
- non-invasive ventilation in postoperative management
- general
- will wear mask
- hemodynamically stable
- alert, awake
Contraindications
- general
- will not wear mask
- hemodynamically unstable
- obtunded, stuperous, coma
- does not improve exercise capacity in patients with COPD[3]
Benefit/risk
Diagnostic procedures
- polysomnography may be helpful to establish optimal inspiratory & expiratory pressures for nocturnal BiPAP
Procedure
- both inspiratory & expiratory pressure are applied by a mask during the respiratory cycle
- the inspiratory & expiratory pressures are set independently[2]
- like CPAP, may be used as nocturnal procedure
Mechanism of action
- inspiratory support decreases work of breathing.
- expiratory support (CPAP) improves gas exchange by preventing alveolar collapse
- noctural BiPAP decreases nocturnal pCO2, daytime pCO2, & sleepiness
- benefit in heart failure may be due to neural changes, not simply alteration of preload[5]
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 189
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17. American College of Physicians, Philadelphia 2006, 2012, 2015
- ↑ 3.0 3.1 Moga AM, de Marchie M, Saey D, Spahija J. Bi-level Positive Airway Pressure (BiPAP) with Standard Exhalation Valve Does Not Improve Maximum Exercise Capacity in Patients with COPD. COPD. 2014 Jun 19. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/24946024
- ↑ 4.0 4.1 4.2 Galli JA, Krahnke JS, James Mamary A et al Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD. Respir Med. 2014 May;108(5):722-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24702885
- ↑ 5.0 5.1 5.2 5.3 Yoshida M, Kadokami T, Momii H et al Enhancement of cardiac performance by bilevel positive airway pressure ventilation in heart failure. J Card Fail. 2012 Dec;18(12):912-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23207079
- ↑ 6.0 6.1 Vital FM, Ladeira MT, Atallah AN Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2013 May 31;5:CD005351. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23728654
- ↑ Hardiman O. Management of respiratory symptoms in ALS. J Neurol. 2011 Mar;258(3):359-65 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21082322
- ↑ Bach JR, Goncalves MR, Hon A et al Changing trends in the management of end-stage neuromuscular respiratory muscle failure: recommendations of an international consensus. Am J Phys Med Rehabil. 2013 Mar;92(3):267-77. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23051760
- ↑ 9.0 9.1 Kusniar TJ, Morgenthaler TI Treatment of complex sleep apnea syndrome. Chest. 2012 Oct;142(4):1049-57 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23032455
- ↑ Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med. 2011 Jun;37(6):918-29. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21424246
- ↑ 11.0 11.1 Weng CL, Zhao YT, Liu QH, et al. Meta-analysis: Noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med. 2010;152(9):590-600 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20439577
- ↑ 12.0 12.1 Nava S, Grassi M, Fanfulla F, et al. Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial. Age Ageing. 2011; 40:444-450 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21345841
Patient information
bilevel positive airway pressure (BiPAP) patient information