That said, I thought I'd write here some of the indications for BiPAP in the emergency room or in the hospital. Basically, it comes down to the following:
- To improve ventilation. To blow off CO2 (IPAP)
- To improve oxygenation. (EPAP)
- Increased CO2 due to decreased airway resistance such as in COPD
- Respiratory failure due to accessory muscle fatigue
- Hypoxemia due to respiratory failure that results from pulmonary edema, atelectasis, pulmonary embolis, and pneumonia
Contraindications would include the following. Pay attention to these, because I've had to remind doctors of these from time to time:
- Inability of patient to protect his own airway (decreased level of consciousness)
- Increased secretions (i.e. pulmonary edema, increased sputum production)
- Any patient at risk of vomiting (post stomach surgery, drug overdose). In this case you may be able to use BiPAP if an NG is inserted.
- Bullous lung disease (emphysema)
- Pneumothorax. (this may be complication due to increased pressure)
- non-compliant patient
I have seen BiPAP ordered on patients that do not fill the above indications. The following are some examples:
- Pulmonary edema to force the fluid out of the lungs (CHF and pneumonia) (Update: T'his has actually been disproved by studies, as I reported on here.)
- Hyperventilation (normal or low CO2, normal PO2)
- Rising yet still normal CO2 on a patient in no respiratory distress.
- To agitate the patient to increase the blood pressure.
Hyperventilation is not an indication for BiPAP, and niether is a normal CO2. And if a patient has a low blood pressure they most certainly shouldn't be hooked up to a BiPAP. Sure it may increase intrapulmonary pressure, but it may also decrease the blood pressure and put the patient at an increased risk of having a heart attack (MI).
The following were used as references for this post: