Continuous Positive Airway Pressure (CPAP)
Bi-level Positive Airway Pressure (BiPAP)
• Non-invasive Negative Pressure Ventilation(NINPV)
NIPPV
It uses a face mask, nasal mask, or helmet mask. It delivers forced air into lungs causing expansion of thoracic cavity and a positive pressure inside the lungs.
CPAP
• The machine delivers the same pressure during inspiration and exhalation.
• It allows pressurized air to splint open the upper airway throughout respiration.
• The pressurized air is titrated (cm H2O) according to the patient’s response.
• CPAP machines can deliver pressure from 4 to 30 cm H2O.
• It uses a mask that covers either the nose or both the nose and mouth.
• It is most commonly used in obstructive sleep apnea.
BiPAP
• The machine delivers different pressures in inspiration and expiration.
• The inspiratory positive airway pressure is higher than the expiratory positive airway pressure and supports the work of breathing.
Indications in ICU
• COPD, acute exacerbation
• Acute pulmonary edema
• Acute respiratory failure in immunocompromised patient
• Decompensated obstructive sleep apnea
• Pneumonia
Contraindications
- Severe facial trauma or burns
- Severe epistaxis
- CSF leak
- Unconscious patients
- Seizure
- Stroke
- Increased ICP
- Cardiac arrest
- Vomiting
- Upper GI bleed
- Recent stomach surgery
- Systolic pressure < 90
- Risk of aspiration
- Penetrating chest trauma
- Pneumothorax
- Poor compliance
- Increased secretion
Complications
- Excess gas in stomach causing bloating and discomfort
- Nasal congestion
- Increased ear pressure
- Headache
- Skin necrosis
Common parameters in practice
- Pressure
Inhaled – 6 to 12 cmH2O (IPAP)
Exhaled – 3 to 6 cmH2O (EPAP)
Start with pressures 10 (IPAP)/5(EPAP)
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