BPAP

BPAP, short for bilevel positive airway pressure, is a form of noninvasive ventilation that provides two levels of airway pressure during the breathing cycle: a higher inspiratory positive airway pressure (IPAP) during inspiration and a lower expiratory positive airway pressure (EPAP) during expiration. A BPAP device toggles between these pressures in response to the patient’s breaths or at a preset rate and is often used with humidification. Compared with continuous positive airway pressure (CPAP), BPAP offers additional inspiratory support to augment ventilation.

Indications for BPAP include acute care scenarios such as respiratory failure due to COPD exacerbation, acute cardiogenic pulmonary edema, obesity-hypoventilation syndrome, and selected cases of post-extubation support. It is also employed in sleep-disordered breathing when standard CPAP is poorly tolerated or insufficient. BPAP can improve tidal volume, reduce work of breathing, and enhance gas exchange, and in some populations may reduce the need for invasive mechanical ventilation.

Delivery and monitoring involve a facial or nasal mask, proper fit, and ongoing clinical assessment. Settings typically include IPAP and EPAP adjustments to achieve adequate ventilation and oxygenation, with a possible backup rate for patients with hypoventilation or apneic events. Common ranges are IPAP roughly 8–20 cm H2O and EPAP roughly 4–6 cm H2O, though individual titration is required. Humidification is frequently used to improve comfort.

Contraindications and risks include inability to protect the airway, excessive secretions, altered mental status, facial trauma, recent facial surgery, high risk of aspiration, or severe hypoxemia unresponsive to noninvasive support. Possible adverse effects are skin breakdown, nasal dryness, gastric distention, and, rarely, pneumothorax or hypotension. BPAP is not a substitute for invasive ventilation in patients with progressive respiratory failure or deteriorating clinical status.