BiPAP

By impactEDnurse • Apr 27th, 2006 • Category: the nurses desk:

BiPAP or Bi-level Positive airway pressure is used to restore functional residual capacity (FRC) – the volume left in the lungs at the end of a resting exhalation. This residue allows more efficient gas exchange at the alveoli and hence improves oxygenation.

It is also known as non-invasive positive pressure ventilation (NPPV).
It differs from Continuous Positive Airway Pressure (CPAP) in that it provides assistance with ventilation. CPAP only provides a constant positive pressure.

BiPAP is used to treat hypercapnoeic respiratory failure. Examples of this might include: Sleep apnoea, chronic airway limitation (CAL) and some neuromuscular disorders. Recent studies have found it effective in the treatment of hydrostatic pulmonary oedema and pneumonia.To achieve BiPAP a patient ventilator interface (known in the business as the face mask) is secured snugly to the patients face (usually with the aid of elastic straps).
Fractional concentration of inspired oxygen (FiO2) is titrated via a flow valve to meet patient requirements.

When the patient begins to breathe in a transducer in the unit senses the decrease in airflow within the circuit and delivers IPAP supporting the patient’s inspiratory effort and producing a larger tidal breath. As the patient finishes her inspiration the transducer senses the drop in inspiratory flow and allows the patient to exhale with pressure support (PS) to the EPAP level.(IPAP-EPAP=PS)

Most machines permit spontaneous breathing by the patient (assist mode) or degrees of machine cycled ventilation (control mode).
IPAP is usually set at 5-10 cmH2O.
EPAP is commenced at 3-5cmH2O.
Settings are increased in 3-5cmH2O increments if the patient is not improving.
If no improvement is seen after around and hour, other interventions should be considered.

Complications:

  • Claustrophobia.
    With a multitude of facial contours, it is important that the mask fits tightly with minimal air leakage. In order to ensure patient compliance the patient must be made as comfortable as is possible. Reassurance, explanation and vigilance are mandatory.
  • Pressure areas around the mask. Most modern BiPAP machines will compensate for some gas leakage around the mask but even so they must still be applied fairly firmly.
  • Dryness of lips and nasal passages.
    Consider some lip balm or perhaps a saline spray to moisten the oral mucosa.
  • Gastric distension from swallowing air (aerophagia) which may lead to…
  • Risk of aspiration.
    Watch for signs of nausea and consider and anti-emetic. Always use a clear mask to make sure you are not ventilating your patient with her breakfast.
  • Hypoventilation due to air leaks around the mask.
  • Corneal irritation from air constantly blowing onto the eyes.

Observations:

Constantly use your clinical expertise to evaluate the effectiveness of BiPAP therapy.
Watch respiratory rate and effort (paradoxical breathing and accessory usage) as well as level of consciousness and Sa02.
Auscultate the lung fields.
Monitor arterial blood gasses.
If you feel your patient is deteriorating.. get them reviewed by a senior doctor.

impactEDnurse is also known as Ian Miller, a nurse with over 26 years experience working in a busy emergency department in, Australia. This site in no way reflects the opinions of that hospital. All stories (although based on actual experiences) have been changed to protect patient confidentiality.
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8 Responses »

  1. Linda Rodgers on July 15th, 2006 at 2:59 pm:

    Concise and to the point. Thankyou

  2. Martha keogh on September 29th, 2006 at 10:59 pm:

    easy to read, with no long jargon

    thank you

  3. shiyas on July 10th, 2008 at 4:29 pm:

    please specify the settings of bipap in different conditions such as copd, pulmonary edema and so on

  4. Jean-Mari on July 31st, 2008 at 12:59 am:

    I am 22 years old and i am also on a bipap machine during the night when i am sleeping. Two years ago a got a virus in my diafragma and my diafragma did not work at all, but luckely it is starting to get better. My bipap machine works through my nose, for me it is mutch better than over my mouth.

  5. Jasmine Tan on June 4th, 2009 at 1:04 am:

    I am a newly graduated staff nurse. I’ve got a trachy patient with Bipap. The oxygen concentrator shows the FiO2 right? What does the reading means? I do not know how to interpret it. Thanks!

  6. Geoff Bartram on October 5th, 2009 at 4:25 pm:

    Over 20 years ago I worked as a mountaineering guide in the Andes. We carried positive pressure masks (positive pressure on the exhalation) to use on clients suffering from pulmonary oedema and they were successful in giving us therapy while we were evacuating the patient to lower elevations. They seemed to be very successful while being portable – in contrast to say a Gamow Bag which prohibits any movement while the patient is being treated. I recently have taken on the task on training young adventurers in Manali, NW India who want to form a rescue association. They deal with a lot of altitude problems because tourists can get to high altitudes very quickly. So I am looking for positive pressure masks for their rescue kit, they must be inexpensive and portable as these young people have lotss of enthusiasm and committment but very little money. Can anyone here help? – any advice will be very gratefully received
    Thanks
    Geoff Bartram

  7. Mary on May 7th, 2010 at 1:56 pm:

    In reply to Geoff, you would need to have the machines (either CPAP or BiPap) along with a battery backup because I assume you have no good source of electricity. I bought the battery pack for travel (especially to diffferent countries where the wattage is different or there might be other problems with access to electicity). I am still going to see if I can check the battery pack with my luggage rather than carry it, but the battery pack is very heavy, at least 20 pounds. So it would be tough to add along with everything else. I STRONGLY SUGGEST you consult a well-know sleep specialist with some years of experience–lots of sleep centers have been popping up because of the demand and some doctors just do not know as much as they should. Such a well-trained specialist would be able to tell you if the CPAP or BiPap –I like the BiPap and I think good specialists will start every patient on the BiPap rather than the more uncomfortable CPAP– would even work or be feasible to use in the circumstances you describe. You’d also need to get a prescription for each of the climbers. I doubt any insurance company would cover the cost of the machine for the reasons you describe.

  8. Gina on May 24th, 2010 at 3:37 pm:

    My concern for one of my patients with ALS – he is on the bi-pap constantly and only able to be off for a minute or two at the most. The problem is that the mask has eaten away the bridge of his nose and it is extremely sore and prone to infection. This is a huge problem. Any suggestions would be greatly appreciated.

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