BiPAP

  • What is BiPAP

  • How does a BiPAP machine works

  • BiPAP How to use

 

What is BiPAP?

BiPAP refers to bilevel or two-level positive airway pressure.
Like CPAP, this OSA treatment works by sending air through a tube into a mask that fits over the nose.

While CPAP generally delivers a single pressure, BiPAP delivers two: an inhale pressure and an exhale pressure. These two pressures are known as inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP).

BiPAP machines are sometimes also called BPAP machines. BiPAP was originally a brand name, but it has become synonymous with the machine itself and is now more common than BPAP.

BiPAP machines have similar low range pressure zones as APAP and CPAP, but they offer a higher peak pressure flow of 25 cmH2O. Thus, this machine is best if you need moderate- to high-pressure ranges.

NIV is often described as BiPAP, however, BiPAP is the trade name. As the name suggests provides differing airway pressure depending on inspiration and expiration. The inspiratory positive airways pressure (iPAP) is higher than the expiratory positive airways pressure (ePAP). Therefore, ventilation is provided mainly by iPAP, whereas ePAP recruits under ventilated or collapsed alveoli for gas exchange and allows for the removal of the exhaled gas. In the acute setting, NIV is used in type 2 respiratory failure (for example in a COPD exacerbation), with respiratory acidosis (pH < 7.35)

If you have sleep apnea or another condition that affects your breathing, your doctor might have mentioned a bilevel positive airway pressure machine, or BiPAP, to you. Sometimes called a BPAP, it’s a device that helps you breathe.

Some medical problems can make it hard for you to breathe. In these cases, you might benefit from bilevel positive airway pressure. It is commonly known as “BiPap” or “BPap.” It is a type of ventilator—a device that helps with breathing.

During normal breathing, your lungs expand when you breathe in. This is caused by the diaphragm, which is the main muscle of breathing in your chest, going in a downward direction. This causes the pressure to drop inside the tubes and sacs of your lungs. This decrease in pressure sucks air into your lungs. They fill with oxygenated air.

If you have trouble breathing, a BiPap machine can help push air into your lungs. You wear a mask or nasal plugs that are connected to the ventilator. The machine supplies pressurized air into your airways. It is called “positive pressure ventilation” because the device helps open your lungs with this air pressure.

BiPap is only one type of positive pressure ventilator. While using BiPap, you receive positive air pressure when you breathe in and when you breathe out. But you receive higher air pressure when you breathe in. This setting is different from other types of ventilators. For instance, continuous positive airway pressure (CPAP) delivers the same amount of pressure as you breathe in and out. Different medical problems may respond better to BiPap versus CPAP.

How does a BiPAP works?

Atmospheric air goes to the blower of the machine through the filters. The blower compresses the air and sends high-pressure air to the connecting tube. Then the air goes to the patient through the nasal mask.

The pressure sensor senses the air pressure in the connecting tube. This sensed pressure goes to the microprocessor. Then the microprocessor analyzes the variation among the set and obtained pressure value. In case of any variation, it either increases or decreases the voltage signal of the driver motor. This, in turn, controls the speed of the blower. Based on the companies there can be some variations

Inspiration increases the volume of the lungs. This causes a sudden drop in intra-alveolar pressure. On sensing this drop of pressure, the machine applies pressure equal to IPAP. The pressure gradient (IPAP> intra-alveolar pressure) causes air to flow from the machine to the lungs. At the end of the inspiration, intra-alveolar pressure becomes equal to IPAP.

The expiration might be triggered by the drop in the air inflow to the threshold value. On, detecting the decreased air inflow, EPAP is applied by the machine. The expiration causes a fall in the intra-alveolar pressure. Once the pressure lowers below EPAP value, IPAP pressure activates again for the next breathing cycle.

How to use a BiPAP

You might receive BiPAP therapy while at the hospital for a breathing emergency. You also might use it at home for a chronic condition.

Follow your healthcare provider’s instructions about when to use BiPAP. You might need to use it only while you sleep. Or you might need to use it all the time. You will not receive the full benefits from your BiPap therapy if you don’t use it as directed.

When you first start using BiPAP, you may feel uncomfortable. It may feel odd wearing a mask and feeling the flow of air. Over time, you should get used to it. If you feel like you really can’t breathe while using BiPap, talk with your healthcare provider. He or she may need to adjust the pressure settings on your machine.

It’s important not to eat or drink anything while using BiPAP. You might inhale food or liquid into your lungs if you do so.

The noise from most BiPap machines is soft and rhythmic. If it bothers you, try using ear plugs. If the device is very loud, check with the medical supplier to make sure it is working correctly.

Talk with your healthcare provider if you are having any symptoms or problems while using BiPAP. He or she can help you figure out how to address them. Here are some general tips:

A humidifier may help reduce nasal dryness. Using a facial mask instead of a nasal mask may also help lessen any eye or sinus symptoms. If you get headaches, they could be due to sinus congestion. In some cases, your healthcare provider might prescribe an antihistamine for these symptoms.
If you have a leaky mask, skin irritation, or pressure lines, you may need a different size or type of mask. You may also find that adjusting the straps around your mask helps.
Your healthcare provider may be able to help you avoid stomach bloating by reducing the pressure setting on your machine.
Your healthcare provider may give you other instructions about the best way to use your machine.

BiPaP Operation
Connect the AC cord to the machine and the power supply
Connect connecting tube, mask, and humidification tank (if needed)
Turn on the machine
Pre-heat the water of the humidifier before use (30 mins earlier)
Set the parameters in your setting option. The values will be prescribed by your doctor.

Handling
Use soap water to clean mask and humidification tank
Do not use alcohol to clean the machine. You can use Collins.
Always use distilled water in the humidification tank
An ultra-fine filter is disposable
The film filter is washable (life span: 6 months)
Check for any leakage in the tubing system.

BiPaP instructions
Levels of pressure
Inspiratory Positive Airway Pressure (IPAP):- It is the pressure that is applied during inspiration. The set value for IPAP generally ranges from 10 to 20 cm H2O.
Expiratory Positive Airway Pressure (EPAP):- It is the pressure that is applied during expiration. The set value for EPAP generally ranges from 5 to 12 cm H2O.
(Inspiration is an active process that needs more energy than expiration. Similarly, expiration is a passive process that does not need much energy. Thus IPAP is always greater than EPAP.)

BiPAP Setting
1. Modes of BiPAP
CPAP mode:- Provides a single continuous airway pressure during inspiration and expiration.
APAP mode:- APAP stands for Auto CPAP. It is an advanced version of the CPAP mode. Here, the machine will automatically set and change the CPAP pressure based on the requirement of the patient.
S mode: Spontaneous mode in which the patient controls the breathing cycle.
T mode: Timed mode in which the alteration between IPAP and EPAP is based on the set time.
S/T mode: It is a combination of both the spontaneous and timed mode. If the patient is unable to breathe spontaneously within the set time, the timed mode will work. Else, the spontaneous mode will operate.
2. Parameters
Different models of the machine allow the users to set different parameters. Some, of the major ones, are as follows:

EPAPmin = 4 cm H2O
IPAPmax = 20 cm H2O
PSmin = 3 cm H2O
PSmax = 15 cm H2O
(Note:- Even though there are multiple parameters in the machine, you really do not need to alter those values for most of the cases. The general parameters that you need to worry about is the IPAP and the EPAP pressure.)

The machine can also have the following features.

Inspiratory to Expiratory (I: E) Ratio
Actual Breathing Rate
Estimated Tidal Volume, Minute Volume, and Air Leakage
No. of Apneas
Alarm button, alarm reset, etc.

Will I Always Have to Use BiPAP?
It’s important to follow your doctor’s instructions on how and when to use your BiPAP. If your health problems and breathing improve, you may be able to lower the pressure on your machine or use it less often. Your doctor will work with you to figure out when it’s time for a change.

If your medical problem gets better, you may be able to start using less pressure on your BiPap machine. Or you might be able to use the machine less frequently. Work with your healthcare team to help get the best treatment.

What are the risks for BiPAP use?
BiPAP is usually very safe. It has a lower risk of complications, such as infection, compared with ventilator support like a tracheostomy. Most problems from BiPAP involve the facemask. It may fit too tightly.

Some other risks include:

Local skin damage from the mask
Mild stomach bloating
Dry mouth
Leaking from the mask, causing less pressure to be delivered
Eye irritation
Sinus pain or sinus congestion
Your own risks may differ depending on your age, the amount of time you need BiPap, and your medical problems. Talk with your healthcare provider about any concerns.