Bilevel positive airway pressure
Bilevel positive airway pressure (BPAP), commonly referred to by the trademarked names BiPAP and BIPAP, is a form of non-invasive mechanical pressure support ventilation that uses a time-cycled or flow-cycled change between two different applied levels of positive airway pressure.[1][2] It generates inspiratory (IPAP) and expiratory (EPAP) pressure gradients that complement the patient's own respiratory cycle, optimising the lungs' efficiency and reducing the work of breathing. BPAP has been shown to be an effective management tool for chronic obstructive pulmonary disease and acute and chronic respiratory failure.[3]
BPAP should be distinguished from continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle and is used for different clinical conditions.
Use
Bilevel positive airway pressure is used when positive airway pressure is needed with the addition of pressure support. Common situations where positive airway pressure is indicated are those where taking a breath is difficult. These include pneumonia, chronic obstructive pulmonary disease, asthma and status asthmaticus.[4][5]
Settings and measurements
- IPAP: this is the pressure applied during patient triggered breaths.
- EPAP: this is the pressure applied in between patient triggered breaths. It could also be considered a continuous positive pressure.
- FiO2: The fraction of O2 percentage that is being added to the delivered air.
- Vf: on many machines a respiratory rate is set as a guarantee for intermittent bursts of IPAP.
Terminology
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- BIPAP The term "Biphasic/bilevel ventilation" was used to describe a mode of ventilation that alternates PEEP levels presented in 1988 by Professor Benzer of Innsbruck and his group. The term for this mode, as used by Draegar on their ventilators is "BIPAP" (note Uppercase "I").
- BiPAP is used by Respironics and others to denote their implementation of non-invasive pressure support plus CPAP (note lowercase "i").
References
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