Bilevel Positive Airway Pressure (BiPAP) – High-flow Oxygen Delivery (Nursing)

00:00 So remember that bilevel positive airway pressure, BiPAP? It's delivered by means of that tight-fitting mask. That was already on our chart. So now we're just reviewing information that you already know. Cool. Because we know that repetition is the best way for you to retain information. A BiPAP machine can also be considered a type of ventilator. Now it's not as super fancy as a ventilator we use for a patient who's intubated, but sometimes someone will refer to it as a BiPAP machine or a ventilator. That's the one that's capable of delivering 2 airway pressures, an inspiratory one and an expiratory pressure. So, I want to talk about the inspiratory pressure or the IPAP. That's what that means. We're going to look at the IPAP and the EPAP which is the expiratory pressure. Remember, it's higher pressure on inspiratory, right, so higher effort, higher level when they're breathing in because that shouldn't increase the workload of the patient. So, pretty normal for you to set a patient at 12 cm of water. So, that can be elevated, it can be crinked up higher if the patient needs it depending on their response to the IPAP. Okay, so we can go all the way up to 20. So just to give you a frame of reference, the normal pressures for the inspiratory pressure would be somewhere around 12, it's pretty average but it can go as high as 20. Now what about the expiratory pressures? Remember it's similar to peep on CPAP and it is usually set between 4 and 6. Okay now start and look and compare those. Inspiratory is usually 12, expiratory is half or a little less than that. Now pause the video, see if you can recall why is that. Why do we have the expiratory pressure like half or less than the inspiratory pressure? Okay cool. You've got that concept which we repeated throughout the video, now you're catching on to be able to answer the questions on your own. Now, not all BiPAP settings are alike. There are several modes, we call that, several different options or settings are available on BiPAP machines. Now they might be spontaneous, they can be spontaneous with timing or there could be pressure control like it will respond to the pressures. So it can be pressure controlled and time. Now these settings differ depending on the model and brand of the BiPAP and these settings will be specifically prescribed by the physician. So, inspiratory pressures, we got kind of a summary here. Inspiratory pressures start 10-15, usually 12 is pretty average, maximum is 20-25.

02:50 See IPAP greater than 20 puts you at some unique risks for a patient. Remember when you learn CPR and they always told you don't overinflate the patient's lungs because you could have gastric distension, that's what you could cause. Then you have an increased risk for aspiration. Also, it's going to mess with the diaphragm because if you have blow all this up the diaphragm doesn't have as much room. So that's why we don't really want to be greater than 20 definitely for not very long because we're going to risk what, gastric distension, aspiration, and the diaphragm has a decreased excursion. That means it doesn't have enough room to function and do what it needs to do. So those are great reminders for what you'll see in inspiratory pressure. Now expiratory pressure starts at 4-5. Remember, it's a lot less than inspiratory pressure, maximum about 10-15. Now this is for your average BiPAP patient.

03:50 There could be extreme cases, you're going to collaborate with a healthcare provider and they maybe outside of this range but your healthcare provider is going to have a valid rational for why they're outside of this range. Because it's all about personalization. A BiPAP device can deliver pressure that matches the patient's individual breathing pattern because it uses this complex algorithm and chart. It's really cool. Now that's a fancy BiPAP. Right? But this allows for a really individualized delivery of oxygen therapy for each patient. So we can make it more comfortable and effective. Now, as comfortable as you can be with a mask strapped on your face and having respiratory trouble, but the BiPAP gives as many more options than a CPAP does. Oh, now we get to talk about working with some of my favorite people in the hospital.

04:44 When you have a respiratory patient, a respiratory therapist, you with them make an awesome team. So, always get to know the respiratory therapist, respect their level of expertise because they know a lot; about the lungs, about respiratory therapy, oxygen delivery methods, learn from them. They are a wealth of information and together the two of you as a team can provide even better care for your patient. Because this is not a normal type of treatment for your patient. This is going to seem kind of uncomfortable for them. They may need a fairly long adjustment period to this type of therapy, it's just not natural to how this mask strapped to your face with these different pressures blowing in your mouth. So, be patient with your patient and understand that this could be difficult for them to adjust to. One good strategy or intervention is allow the patient, if they can, to self-apply the mask. So hand in the mask, let them be in control of putting it on. So you want to start with possibly about 2-3 cm of inspiratory pressure. That's the IPAP. Remember we're going to start slow. So give them control by allowing them to put on the mask and then gradually start those inspiratory pressures at like 2-3 cm. Remember, we're going to end up higher than that, but you want to just start them off solely so they kind of get the feel and get adjusted to it and get used to it.

06:20 Now if their oxygenation is adequate, then the expiratory pressure could start at zero. So we'll just have a little bit of pressure on inspiratory and zero on expiratory if the patient can tolerate it and maintain in appropriate oxygenation. Now gradually and slowly, you're going to increase that expiratory pressure, just what you need to do to maintain the oxygenation.

06:45 Now next, you're going to gradually increase that inspiratory pressure. We want it to be higher than the expiratory pressure because our goal is to increase that tidal volume, the amount of breath they are taking in. So now you're gradually increasing that inspiratory pressure. So, patients can be given breathing treatments with like adrenergic or other types of medications as required through the BiPAP machine. So we're not going to have to take that off of them if they need to get medications that are right through the machine.