Overview
Non-invasive ventilation should occur in an appropriate venue with sufficiently trained staff, such as a respiratory ward, HDU or ICU.
CPAP
Continous positive airway pressure (CPAP) splints the upper airways open, and relieves upper airway obstruction. This device does not actively ventilate the patient.
Indications for CPAP
- Obstructive sleep apnoea
- Acute pulmonary oedema
BiPAP
Bilevel positive airway pressure (BiPAP) provides both expiratory positive airway pressure (EPAP), which opens the airways; and inspiratory positive airway pressure (IPAP), which ventilates the patient.
Indications for BiPAP
- Acute hypercapnic respiratory failure - e.g. due to COPD, chest wall deformities, neuromuscular disorders
- Immunocompromised patients with acute respiratory failure
- Step-down after extubation of high-risk patients
Contraindications to BiPAP
Absolute
- Severe impairment of consciousness
- Severe facial deformity
- Inability to maintain or protect the airway
- Upper airway injury - burns, trauma, surgery
- Haemodynamic instability
- Untreated pneumothorax
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