Bilevel Positive Airway Pressure
Nadav Traeger, MD, FAAP, FCCP, DABSM, and Priya Prashad, MD
Introduction
•Bilevel positive airway pressure (BiPAP) is a form of noninvasive respiratory support that delivers 2 levels of positive pressure.
Uses/Indications
•The same indications apply to BiPAP as to continuous positive airway pressure (CPAP; see Chapter 114), but some patients may tolerate BiPAP better because it has a lower exhalation pressure and a lower mean airway pressure.
—Treatment of clinically significant residual obstructive sleep apnea (OSA) after adenotonsillectomy or other upper airway/ craniofacial surgery
—Treatment of OSA when either the patient or the parents prefer a nonsurgical option
—Treatment of OSA in those who are not surgical candidates because of other medical issues (eg, severe obesity, bleeding diathesis, atlantoaxial instability) and/or who have small tonsils and/or adenoids
•In addition, BiPAP is used in situations where pressure support is needed—that is, as a means of providing noninvasive ventilation for treatment of hypoventilation or central apneas.
•BiPAP is used in hospitals for treatment of acute respiratory failure; the device settings are chosen and adjusted on the basis of clinical response, pulse oximetry values, and blood gas analyses.
•BiPAP is used at home for the treatment of chronic respiratory failure; the device settings are chosen and adjusted mostly on the basis of overnight polysomnography (sleep study) results, in addition to clinical response.
Device Settings
•BiPAP machines may have a number of different settings. The common ones are listed here.
—Inspiratory positive airway pressure (IPAP): The pressure applied during patient-triggered breaths, similar to pressure support
—Mode: Typical options are S (spontaneous), S/T
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