Operation Skills for BiPAP

Table of Contents

Key Index for the First Time Use

Key index for the first time use of the machine: tidal volume above 500mL and stable respiratory frequency BPM(breath per minute).

The Initial Pressure Adjustment Parameter

The initial pressure adjustment parameter (if the patient used BIPAP before, keep the original parameters ). Check the pressure  and airflow waveform on the screen to see the effect.

Pressure and Airflow Waveform

Normal Breathing Waveform

  • High tidal volume
  • Stable BPM
  • Inspiration platform is stable

COPD Treatment Waveform

  • Tidal volume>500
  • Air leak stable<30L/min
  • Minute volume>8L
  • Have inspiratory platform
  • Expiratory Time>
  • Inspiratory Time

No adjustment

  • Observation more than 30 minutes
  • BPM <25
  • SpO2 >90

Expirate Level is Too Slow

  • Have inspiratory platform
  • There is a rising tip in the late stage of the inspiratory platform.
  • Increased expiratory work

Adjust

  • Expirate level -2

Rapid Shallow Breathing

  • BPM is too fast
  • No inspiratory platform
  • Low tidal volume
  • Pressure waveform is sharp wave

Adjust

  • IPAP+2
  • Expirate level+2
  • Inspirate Sensitivity+1

Double Triggered Breathing

  • 2 consecutive waveforms
  • No obvious respiratory cycle
  • Low tidal volume

Adjust

  • Inspirate Sensitivity+1

Backup Rate Trigger

  • Breathing is triggered by backup  rate
  • Have inspiratory platform

Adjust

  • Inspirate Sensitivity-1
  • Reduce backup rate (when necessory)

BIPAP Common Problems

Difficulty in Breathing

Reasons

  • Nervous, fear to wear nasal/mask
  • Overbreathing
  • Premature breathless
  • EPAP is too high, affecting hemodynamics
  • Insufficient pressure support
  • There may be undetected contraindications, such as an undrained pneumothorax

Solutions

  • Strengthen patient counseling and training
  • Adjust the proper EPAP
  • Adjust the proper pressure support
  • Careful examination of the contraindications

Poor Synchronization

Reasons

  • Air leakage is too large
  • Excessive water in the tubing
  • Machine fault

Solutions

  • Adjust nasal/mask wear and reduce air leakage
  • Remove the tubing water, adjust the appropriate humidification temperature
  • Repair

Low SpO2

Reasons

  • EPAP too high or too low
  • Oxygen source problem
  • FIOZ too low
  • Excessive secretions, poor discharge
  • Air leakage is too large
  • Inadequate treatment time

Solutions

  • Adjust EPAP and IPAP.
  • Check oxygen source
  • Increase inhaled oxygen flow
  • Sputum suction
  • Adjust nasal/mask wear and reduce air leakage
  • Extend treatment time

High CO2

Reasons

  • Insufficient pressure support
  • Air leakage too low
  • EPAP too low
  • Much sputum
  • Inadequate treatment time

COPD combined OSA, nightime EPAP level is not adjusted

Solutions

  • Increase pressure support
  • Increase air leakage
  • Open all openings of mask or adjust mask loose properly.
  • When IPAP<15cmH2O , use platform exhaust valve
  • Adjust EPAP to offset PEEPi and reduce repetitive breathing
  • Sputum suction
  • Extend treatment time
  • Adjust nighttime EPAP and IPAP level
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