How and when to start BiPAP and CPAP
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Non-invasive ventilation (NIV) refers to CPAP and BiPAP. This page explains the practicalities of starting a patient on NIV. See the intensive care pages for details and specific indications for CPAP and BiPAP (and high flow nasal oxygen – ‘HFNO’ or ‘optiflow’)
CPAP and BiPAP basics
CPAP (continuous positive airways pressure)
CPAP is delivered with a tight fitting mask attached to a ventilator. It gives a continuous pressure (analogous to PEEP: positive end expiratory pressure).
Usual settings are 5, 7.5 or 10 cmH20
CPAP is commonly used in acute pulmonary oedema after medical management has failed
The aim of CPAP is to splint airways, reduce alveolar collapse, enable alveolar recruitment and to increase the functional residual capacity
BiPAP (bilevel positive airways pressure)
BiPAP is also delivered by means of a tight fitting face mask but the ventilator delivers two different airway pressures. These are an inspiratory pressure and an expiratory pressure.
The expiratory pressure (EPAP) is analogous to PEEP on CPAP and is usually set between 4-6 cmH2
The inspiratory pressure (IPAP) is a higher pressure which aims to augment the patient’s inspiratory effort
Common settings for IPAP are 12 cmH20 which can then be escalated depending on the patient response. It can go up to 20 cmH20 if needed.
BiPAP is used to treat type 2 respiratory failure and is commonly used in exacerbations of COPD but only after full medical management in appropriate patients.
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