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