BIPAP

BiPAP, or bilevel positive airway pressure, is a form of noninvasive ventilation that provides two different air pressures during the breathing cycle. A machine delivers a higher pressure during inhalation (IPAP) and a lower pressure during exhalation (EPAP) through a facial or nasal mask. This setup assists inhalation by increasing tidal volume while helping to keep airways open during exhalation, improving gas exchange and reducing the work of breathing.

Indications for BiPAP include acute or chronic respiratory failure due to conditions such as COPD exacerbations, congestive heart failure, pneumonia, or neuromuscular disorders; post-extubation support; and certain palliative care situations. It is not suitable for patients who cannot protect their airway, are vomiting or have a high risk of aspiration, have facial trauma or improper mask fit, or have hemodynamic instability or severe hypoxemia despite ventilation.

Typical settings involve an IPAP and EPAP combination, often with a backup respiratory rate. Common ranges are IPAP 8–20 cm H2O and EPAP 4–6 cm H2O, with adjustments based on comfort, oxygenation, and blood gas measurements. Interfaces include various masks, with humidification and fit critical to tolerability and effectiveness.

Benefits include reduced work of breathing, improved ventilation, and a lower likelihood of intubation in suitable patients. Potential risks are skin breakdown, nasal or oral dryness, aerophagia and gastric distension, barotrauma, and aspiration if vomiting occurs or mask fit is poor.

BiPAP can be used in hospitals and in some long-term or home settings with appropriate monitoring, patient selection, and education on device maintenance and mask fitting. It is distinct from CPAP, which delivers a single constant pressure throughout the breathing cycle.