Bilevel positive airway pressure

Bilevel positive airway pressure (BPAP) is a continuous positive airway pressure (CPAP) mode used during noninvasive positive pressure ventilation. It delivers a preset inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP). B_PAP can be described as a Continuous Positive Airway Pressure system with a time-cycled change of the applied CPAP level.^[1] C_PAP, B_PAP and other non-invasive ventilation modes have been shown to be effective management tools for chronic obstructive pulmonary disease and acute respiratory failure.^[2]

Discouraged terminology

Often B_PAP is incorrectly referred to as "BiPAP". BiPAP® is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver B_PAP.

Settings and measurements

• I_pap — this is the pressure applied during patient triggered breaths.
• E_pap — this is the pressure applied in between patient triggered breaths. Could also be considered a continuous positive pressure.
• FiO₂ — the fractional O2 percentage that is being added to the delivered air.
• V_f — on many machines a respiratory rate it set as a guarantee for intermittent bursts of I_pap.

History

Biphasic/bilevel as a mode of ventilation was first presented in 1988 by Professor Benzer and his group (Innsbruck), his theory consisted of alternating PEEP levels.^[3] This was the first time the acronym BIPAP was used and was followed in 1989 with the publication of a new approach to ventilatory technique^[4] by Baum & Benzer which was also the first full year of commercial introduction of "Biphasic Positive Airway Pressure" as an integrated mode of ventilation on the Evita ventilator. This concept was introduced as a positive adjunct to weaning from ventilator support.

References

1. ^ C. Hormann, M. Baum, C. Putensen, N. J. Mutz & H. Benzer (January 1994). "Biphasic positive airway pressure (BIPAP)--a new mode of ventilatory support". European Journal of Anaesthesiology 11 (1): 37–42. PMID 8143712. 
2. ^ M. A. Levitt (November 2001). "A prospective, randomized trial of BiPAP in severe acute congestive heart failure". American Journal of Emergency Medicine 21 (4): 363–369. PMID 11728761. 
3. ^ Benzer H (1988) Ventilatory support by intermittent changes in PEEP levels. 4th European Congress on Intensive Care Medicine. Baveno-Stresa
4. ^ Baum M, Benzer H, Putensen CH, Koller W. & Putz G (1989) – eine neue Form der augmentierenden Beatmung. Anaesthetist 38:452-458