What is BiPAP? (Bilevel Positive Airway Pressure) | Respiratory Therapy Zone

What is BiPAP? This video will teach you all about Bilevel Positive Airway Pressure!

What is BiPAP?
As I mentioned, BiPAP is a type of noninvasive ventilatory support that gets its name because it provides two levels of pressure:

1. IPAP
2. EPAP

Inspiratory Positive Airway Pressure (IPAP) – An airway pressure that is above 0 cmH2O during the inspiratory phase of breathing. It works similar to the peak airway pressure in traditional mechanical ventilation. So if you increase the IPAP setting, this will increase the delivered tidal volume.

Expiratory Positive Airway Pressure (EPAP) – An airway pressure that is above 0 cmH2O during the expiratory phase of breathing. It works similar to the PEEP in traditional mechanical ventilation or CPAP during spontaneous breathing. Increasing the EPAP setting improves the patient's oxygenation by increasing the Functional Residual Capacity (FRC).

So essentially, you can make adjustments to the IPAP and EPAP settings depending on the patient's ventilatory and oxygenation status. IPAP is what controls the tidal volume that is delivered. EPAP functions as PEEP and supports the patient's oxygenation.

There are (2) primary indications for BiPAP:

1. Acute respiratory failure
2. Acute exacerbation of COPD

And the best way to determine if BiPAP is indicated is to look at the patient's ABG results. If a patient has a decreased pH and an increased PaCO2, you could recognize that ventilatory issues are present and BiPAP would be indicated.

Cardiogenic Pulmonary Edema is another common indication for BiPAP and it's been shown to decrease the need for traditional mechanical ventilation in these patients.

Contraindications for BiPAP:
Apnea
Unmanageable secretions
Facial burns or trauma
Claustrophobia

Making Changes to BiPAP Settings
Depending on the patient's needs, you can make adjustments to the IPAP and EPAP pressure levels in the settings of the machine. This is not always the case, but in general, a good starting point is 10/5.

IPAP = 10 cmH2O
EPAP = 5 cmH2O

The appropriate initial pressure setting for IPAP can range from 8-12 cmH2O. The initial EPAP setting can range from 4-5 cmH2O. The IPAP and EPAP settings can be adjusted in increments of 1-2 cmH2O depending on the needs of the patient.

For example, if the patient is in respiratory acidosis and needs a larger tidal volume to try to decrease the PaCO2 value, you would increase the IPAP. Or, to improve the patient's oxygenation, you would increase the EPAP which essentially is the same thing as increasing the level of PEEP.

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🚑MEDICAL DISCLAIMER
Medicine and Respiratory Therapy are continuously changing practices. The information in this video is for educational and entertainment purposes only. For medical advice, please consult with a physician or qualified medical professional.

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⏰TIMESTAMPS
0:00 - Intro
0:27 - What is BiPAP?
0:32 - Inspiratory Positive Airway Pressure (IPAP)
1:00 - Expiratory Positive Airway Pressure (EPAP)
1:50 - Primary Indications for BiPAP
1:53 - Acute Respiratory Failure
2:20 - Cardiogenic Pulmonary Edema
2:39 - Contraindications for BiPAP
2:57 - Making Changes to BiPAP Settings
3:11 - BiPAP Starting Point

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[DeviantMotives]

What does it say not indicated for apnea because that’s why I’m taking it

[RamonZuniga]

These things are gold if you have lung problems
❤

[pattibaker]

So Bi-Pap shouldn't be used for apnea? I'm confused.

[martinaodiakosa]

Thanks, please how do we do the settings

[simone]

My late father hated the BiPAP. He always pulled off the BiPAP mask from his face. As pointed out in the video, he was put on said machine for pulmonary oedema - complications from his heart failure and chronic kidney disease. Anyway, more power to the Respiratory Therapy Zone channel. This channel is helpful not only to respiratory therapy students but also to laypersons who want to be educated on things related to respiratory health.

[denniswhalen]

Why is a bipap contraindicated for apnea? From a lay user that does not make sense. It is the ONLY way I could use these machines and get some sleep. Was transferred to a bipap from a Capp at the hospital where I was in for heart surgery.

[christinehunter]

Love the simple but excellent presentation

[nasserburhan]

I couldn't thank you more, big love to your all team

[tachnicalbishtji]

Copd patient ko without oxygen bipap machine laga sakte hai kya aur 1 din me kitne ghante plz ans me patient ka co2 level bad jata hai

[Sherlockarim]

if the patient was vomiting we can use nasal mask? but if the patient was unconscious we must do intubation?

[rahulkori]

Thank you so much for vry good information thank you so much 🙏🙏

[enzore]

Io dopo 15 anni di terapia con CPAP non sono riuscito a capirci quanto meno si possa per gestire tali situazioni..Ultimamente mi anno aumentato due volte la pressione, forse in questo periodo di COVID stanno facendo le prove?-

[kimms]

This was very helpful. I hope theres more in the future!

[TheSleepysleep]

I have a question. I recently did a sleep study and was diagnosed with OSA. They prescribed a bipap for me, but I haven't been diagnosed with any other respiratory issues such as respiratory failure or COPD. I noticed that you said that apnea was a contraindication for bipap, but I was wondering what your thoughts were on that.

For context, untreated my AHI was 99.7/hr with O2 sats dropping below 70 untreated during the study and with bipap treatment, it is now averaging 0.1 with a bipap. Do you think that there is another issue I should talk to my respirologist about, or is my apnea severe enough that a bipap is the proper treatment? I also had an Arterial Blood gas test to check my O2 sats and was told it was "low" (they didn't tell me the number). I'm not on oxygen and was not given any diagnosis besides OSA. I'm just curious why a bipap is listed as not recommended for apnea in this video. Thanks!

[fasihayakub]

Hi, would a Bi-Level BiPAP machine be suitable for severe sleep apnoea person? Or should such an individual use an Autoset CPAP machine? Thanks

[carrynkoo]

Thank you very much. Is easy for me to understand! I appreciate it!

[warunakumara]

sir, thank you for the video lecture, can you please tell that can we change inspiration time and expiration time seperately in a bipap unit

[adolfofireup]

could you do one on sputum colors/ illness, identify and treat?

[nezarrifat]

Good and comprehensive work
Do you mean by IPAP 10 ( 5 above PEEP) or actual 10 above PEEP?

[drxnitishnagar]

Kitney spo2 pay kitney o2 daytay h by mask 80%. Ya 60% spo2 per kitney o2 daygay copd patient ko