Bilevel Positive Airway Pressure (BiPAP)

Topic Name Introduction Clinical Applications Technical Aspects Patient Care

Bilevel Positive Airway Pressure (BiPAP)

Overview

BiPAP is a non-invasive ventilation modality that delivers two different pressure levels - a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP). This dual-pressure system helps maintain airway patency while reducing work of breathing in pediatric patients.

Key Components

• Interface: Nasal masks, full-face masks, or nasal pillows specifically sized for pediatric patients
• Pressure Generator: Microprocessor-controlled blower system
• Monitoring Display: Shows pressure levels, respiratory rate, and leak percentage
• Humidification Chamber: Provides warm, humidified air to prevent mucosal drying

Primary Indications

• Acute respiratory failure
• Chronic respiratory insufficiency
• Obstructive sleep apnea
• Neuromuscular disorders
• Post-operative respiratory support
• Bronchiolitis
• Status asthmaticus

Contraindications

• Unable to protect airway
• Severe hemodynamic instability
• Facial trauma or recent facial surgery
• Active upper GI bleeding
• Untreated pneumothorax

Pressure Settings

• IPAP Range: 4-25 cmH₂O (pediatric)
• EPAP Range: 4-15 cmH₂O (pediatric)
• Recommended Initial Settings:
  • IPAP: 8-10 cmH₂O
  • EPAP: 4-5 cmH₂O
  • Rate: Age-appropriate backup rate

Advanced Features

• Rise Time: Adjustable speed of pressure increase (100-600 msec)
• Trigger Sensitivity: Flow or pressure-triggered
• Leak Compensation: Automatic adjustment for mask leaks
• Alarms: Disconnection, low/high pressure, apnea, low minute ventilation

Implementation Protocol

1. Patient Assessment:
   • Respiratory rate and effort
   • Mental status
   • Hemodynamic stability
   • Facial anatomy for mask fitting
2. Mask Fitting:
   • Select age-appropriate size
   • Ensure proper seal while avoiding pressure points
   • Consider skin protection barriers
3. Monitoring:
   • Continuous pulse oximetry
   • Respiratory rate and pattern
   • Work of breathing
   • Blood gases as indicated

Troubleshooting Guide

• Poor Synchronization:
  • Adjust trigger sensitivity
  • Check for excessive leak
  • Modify rise time
• Mask Leaks:
  • Reassess mask size and fit
  • Adjust headgear tension
  • Consider alternative interface

Further Reading

• Pediatric Non-invasive Ventilation Guidelines
• American Thoracic Society Clinical Practice Guidelines
• Clinical Outcomes in Pediatric BiPAP Use
• CHOP Clinical Pathway for Non-invasive Ventilation