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CPAP vs BiPAP

Discussion in 'ALS Discussion' started by NightHealer865, Sep 18, 2018.

  1. NightHealer865

    NightHealer865 Forum Crew Member

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    For your pulmonary edema/chf patients, which do you prefer? Our vents will do both and we have protocols for both, but this is the first time I've ever had a vent and able to do BiPAP. Why do you prefer one over the other?
     
  2. NPO

    NPO Forum Deputy Chief

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    I always do BiPAP for both pulmonary edema and COPD. I have very good success and it's always been well tolerated. Much more than the ol' Pulmodyne CPAP.
     
    Peak likes this.
  3. Peak

    Peak ED/Prehospital Registered Nurse

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    CPAP is essentially non-invasive PSV - a weaning tool or for very minimal support, BiPAP allows a greater inspiratory pressure without the constant increase in PEEP and many BiPAPs allow setting similar to AC where you can set mandatory ventilation rates and volumes.

    For patients requiring acute respiratory support for whom non-invasive airway management in appropriate we always start with BiPAP in lieu of CPAP. We only use CPAP for chronic patients who are already on CPAP do not have an increased need for support over baseline. I get those plastic disposable CPAPs that 911 ALS carries over nothing, but if you have the option why choose the support with less control? We leave weaning to the ICU/PICU/NICU receiving the patient.
     
    NightHealer865 likes this.
  4. NightHealer865

    NightHealer865 Forum Crew Member

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    That is kinda what I figured, but until recently all I had was the disposable CPAP that every private EMS service carries. Now that I have a ventilator with the BiPAP settings I think I'll try it on my next CHF patient.
     
  5. Brandon O

    Brandon O Puzzled by facies

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    Most folks who are working to breath probably benefit from a little extra inspiratory support. Just bear their disease process in mind to help remind you whether they need mostly IPAP or mostly EPAP.
     
  6. DesertMedic66

    DesertMedic66 Forum Troll

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    I’ve only been able to use CPAP due to being on a ground ambulance with no vent. Now I have full access to a vent. Our preferred mode for CHF/pulmonary edema is CPAP.
     
  7. ThadeusJ

    ThadeusJ Forum Lieutenant

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    When given the choice, most healthcare professionals would prefer Bilevel (BiPAP is a brand name of Respironics) over CPAP because you are able to control more parameters. That being said, I don't believe there is a scientific based consensus on which provides better patient outcomes. Also, Bilevel (at the moment) is only available on vents or non-disposable devices and require more training to use. They will also more expensive, require servicing, a source of power and consume more oxygen resources.

    It all depends on where you are, what training you have and what equipment is available for your service.
     
  8. VFlutter

    VFlutter Flight Nurse

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    Like mentioned If they are at the point of respiratory failure from pulmonary edema then they will likely appreciate the added IPAP with Bilevel.
     
  9. DrParasite

    DrParasite The fire extinguisher is not just for show

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    We typically only use for severe Asthma or CHF.... which is better? is that a preference, or is there a scientific study backing your rational?

    And does anyone carry both CPAP and BiPAP on their truck? I have only seen one system, never 2.
     
  10. NightHealer865

    NightHealer865 Forum Crew Member

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    Our Vents allow both, and we have protocols for both.
     
  11. StCEMT

    StCEMT Forum Deputy Chief

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    I would prefer to have at least the option to use BiPAP, but all we have is CPAP. However, our CPAP is very user friendly, so that is nice.
     
  12. NPO

    NPO Forum Deputy Chief

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    We carry both CPAP and BiPAP
     
  13. Peak

    Peak ED/Prehospital Registered Nurse

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    For any disease process in which the patient works to push air out I think that there is a huge benefit of BiPAP over CPAP, whether it be for COPD, Asthma, or patients who are just getting tired out from breathing.

    I have heard arguments that breath stacking patients benefit less from BiPAP because they let the pressure over-inflate them, I don't buy into this because you can adjust your IPAP and ramp to prevent them from doing this (and have yet to actually see a prehospital or ED patient do this, I've only seen it up in the units). These patients are often so close to complete failure anyway that they often need imminent intubation.

    I think that BiPAP is less adventitious over CPAP in patients where increasing PEEP is our primary goal, for example in CHF or other fluid overload states (for example the septic liver failure patient that we fill with fluids); however BiPAP isn't counter indicated and isn't really detrimental, just less adventitious.

    I would make sure that you have the T-connector for intermittent and continuous nebs, I know that there are some ways to rig it up with the peace pipe nebs but having the connector with a one way valve makes it so much easier to just start a treatment and leave the connector in place.

    Now to search out some literature...
     
  14. Tigger

    Tigger Dodges Pucks Community Leader

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    When we start carrying a real vent we will likely have both CPAP and BiPAP onboard.
     
  15. Peak

    Peak ED/Prehospital Registered Nurse

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    Trials essentially show in adults that CPAP is better tolerated and has better patient comfort than BiPAP, however BiPAP had better outcomes in disease states other than CHF; in CHF there was no difference in outcome between CPAP and BiPAP.

    https://www.uptodate.com/contents/n...&topicRef=3450&anchor=H16&source=see_link#H16
    https://www.ncbi.nlm.nih.gov/pubmed?term=8294627
    https://www.ncbi.nlm.nih.gov/pubmed?term=21136039
    https://www.ncbi.nlm.nih.gov/pubmed?term=10713013

    Peds has less literature on the manner and emphasis other adjuncts for various disease states, for example HHF and cough assist which aren't as relevant to EMS discussions.

    https://www.uptodate.com/contents/n...Title=1~150&usage_type=default&display_rank=1

    Anecdotally we tend to start almost all of our PICU kids BiPAP, we tend to see much more use of CPAP in the NICU. Since of course BiPAP (or any giant mask gripping their face) is often poorly tolerated we often place these kids on precedex and have 1:1 monitoring.
     
  16. RocketMedic

    RocketMedic King of the Improbable

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    Where's this at? I miss vents.
     
  17. RocketMedic

    RocketMedic King of the Improbable

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    For my money, I prefer bilevel NIPPV for its versatility, but it can be difficult to get people used to the dual levels, especially when they're tachypneic and anxious. CPAP really shines in its ability to present a *consistent* pressure, and anecdotally, I find it much easier to tolerate, even the disposable ones. NIPPV through a vent, properly managed, burns a lot less O2 than a Pulmodyne or other oxygen-powered unit.

    I really, really like "ghetto bipap" too. BVM + PEEP valve and a repurposed CPAP mask or BVM facemask actually does a surprisingly OK job, especially with patients who are already so distressed as to be unable to tolerate CPAP.

    Short answer: give me a good vent, the autonomy to use it and let me pick what works best.
     
  18. NightHealer865

    NightHealer865 Forum Crew Member

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    EMSA OKC believe it or not.
     
  19. RocketMedic

    RocketMedic King of the Improbable

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    Ah! You should get a little fire truck lunch box, people will go insane.
     
  20. truetiger

    truetiger Forum Asst. Chief

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    If you have a vent that does both your going to want to almost always use the non-invasive positive pressure ventilation with pressure support...
     

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