INDICATIONBIPAPinvasiveandnonivasiveventilation.pptx

Indications of bipap

1. INDICATIONS OF BIPAP Dr Akhtar Ali

2. Acute exacerbation of COPD

3. In patients with acute exacerbation of COPD pH < 7.35 PCO2 > 6.5 kPa Despite 1 hour optimal treatment

4. Benefits Reduced mortality Reduced need for intubation More rapid improvement in RR, pH & PCO2

5. Decompensated OSA & OHS

6. Recommended as first choice OSA with acute respiratory acidosis OSA with COPD overlap Compensated hypercapnia with day time somnolence When alveolar hypoventilation fails to improve despite CPAP

7. Respiratory failure from neuromuscular weakness and chest wall deformities

8. Indicated in patients with Symptomatic chronic respiratory failure with evidence of Nocturnal or day time hypoventilation FVC < 50% predicted VC < 15-20 ml/kg MIP < -6 cm H2O MEP < 40 cm H2O

9. In stable NMDs patient may remain on NIV for life long e.g with spinal cord injury In progressive NMDs ,its not a cure but delays the need of invasive ventilation e.g with AML

10. Benefits Acceptable quality of life Avoid complications of invasive ventilation (Bleeding, tracheal stenosis, respiratory infections)

11. Community acquired pneumonia

12. Improves oxygenation in severe pneumonia Buys time for mechanical ventilation

13. Cystic Fibrosis

14. Preferred in patients with PCO2 > 55mmHg PCO2 > 50 mmHg with nocturnal desaturation

15. Benefits Improves symptoms Increase exercise tolerance Improves nocturnal hypoventilation

16. Covid-19

17. Preferred over HFNC in Patients having acute hypercapnic respiratory failure with AE COPD Associated with cardiogenic pulmonary edema Associated with OSA, OHS or NMDs

18. Helmet face mask is preferred to avoid risk of aerosol related spread of infection Associated with decrease intubation rate and improves mortality However further research is needed

19. Contraindications of BiPAP

20. Absolute Need for emergent intubation Severe ARDS Cardiac or respiratory arrest Unstable cardiac arrhythmia

21. Relative Hemodynamic instability Impaired consciousness Facial surgey , trauma burns or deformity Copious respiratory secretions

22. Upper airway obstruction Undrained pneumothorax Inability to cooperate or protect airway Vomiting, bowel obstruction, upper GI injury or surgery