BiPAP/CPAP
Formal Definition
Non-invasive positive pressure ventilation modalities: CPAP (Continuous Positive Airway Pressure) delivers a single fixed pressure throughout the respiratory cycle, keeping airways open; BiPAP (Bilevel Positive Airway Pressure) delivers separate higher inspiratory pressure (IPAP) and lower expiratory pressure (EPAP), supporting ventilation in addition to oxygenation.
How It's Used on the Ward
"Put them on BiPAP" or "trial of CPAP" — the step between supplemental oxygen and intubation; buys time and often averts mechanical ventilation in appropriate patients.
Example
""COPD exacerbation with CO2 of 72 and pH 7.30 — not improved after back-to-back nebs and IV methylprednisolone. Starting BiPAP at 12/6, reassess ABG in an hour. If pH doesn't improve or she's tiring, we go to the tube.""
Clinical Context
CPAP: indicated for OSA, cardiogenic pulmonary edema (flushes fluid out of alveoli, reduces preload/afterload). BiPAP: indicated for COPD exacerbation (reduces work of breathing, improves CO2 clearance), hypercapnic respiratory failure, post-extubation support. Contraindications to NIV: inability to protect airway, vomiting, hemodynamic instability, facial trauma, decreased consciousness. Settings: CPAP = single pressure (5–10 cmH2O); BiPAP = IPAP (inspiratory, 8–18) / EPAP (expiratory, 4–8). Failure to improve on NIV = proceed to intubation.
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