CPAP, BPAP, AVAPS - Introduction to Non-Invasive Ventilation Strategies Explained Clearly!

Non-invasive ventilation strategies are used both at home and in the hospital. In this video we discuss the three most common strategies - CPAP (continuous positive airway pressure), BPAP or BiPAP (bilevel positive airway pressure), and AVAPS (average volume assured pressure support). These strategies can be used for both Type 1 (low oxygen or hypoxemia) and Type 2 (high carbon dioxide or hypercapnia) Respiratory Failure. There are multiple different mask types, including nasal, nasal pillows, and full face mask.
We discuss how each of these strategies works from a physiologic standpoint. We then dive into the different settings and how to adjust/program them, including EPAP, IPAP, FiO2, Tidal Volume, Tmin, Tmax, Respiratory Rate, and more! Lastly, we dive into the different indications, such as obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), heart failure (HF), neuromuscular diseases (NMD), obesity hypoventilation syndromes (OHS), and more. We finish out by discussing the contraindications, both absolute and relative.
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DISCLAIMER THIS VIDEO DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources..
#CPAP #bipap #AVAPS #VENTILATION #teaching

[@WhiteboardMedicine]

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[@user-yx7or5qw4u]

Great presentation of topic. As a retired RCP/RRTII, I find this RT concept still fascinating and amused. Kudos to all the hardworking RTs out there chasing their codes and out of ratio pt. assignment.

[@WhiteboardMedicine]

RTs are so critical and often carry some real tough patient ratios. We appreciate you checking out the video and for sharing!

[@haqzahoorul]

The best video on this difficult topic. Thank you very much. Just one clarification; the pressure units are mm of water and not mercury, I think.

[@WhiteboardMedicine]

Thanks for the kind words and for checking out the video! There could be variability between machines, but we believe most are cm of H2O (rather than mm H2O). We misspoke with the mmHg, which is another common pressure measurement unit in medicine! Good eye!

[@timweb1510]

Glad to see the uploads

[@WhiteboardMedicine]

Appreciate that!

[@shizzym]

This was great stuff

[@WhiteboardMedicine]

Really glad to hear it! Thanks for checking out the video and for commenting!

[@GumriRN]

So GLAD you’re back! Waiting for whichever epidemic we’ll face & you’re inimitable way of explaining it.

[@sheryl3268]

Thanks! Looking forward to the deep dives too! Hoping you'll cover differences between mask types, etc. in that. Thanks again!

[@WhiteboardMedicine]

Absolutely! And thanks for checking out another video!

[@iknowheis]

I’ve been missing you! I’ve been concerned about you!

[@Varquar1964]

Patient here - thank you for the video. I was on a CPAP but wasn't compliant due to some claustrophobia issues. Initial presentation was SPO2 in the 20s (according to my records - I wasn't home) and PaCO2 of 90.7. Treatment was the use of a BiPAP which did lower my PaCO2. Discharge dx was COPD and OHS. I was sent home with an IVAPS (I Presume this to be ResMed's version of AVAPS). Again, thank you - I was told non-compliance would result in another bout of hypercapnia but not much on how the new machine would prevent that. Toodles.

[@DrJawwad3]

Hey, medical doctor here. How are you doing now and holding up with the treatment? Complaince with the new Avaps

[@sinclair657]

Thank you

[@WhiteboardMedicine]

Always our pleasure! Thanks for checking it out!

[@dianethoroughman9541]

I was prescribed a bipap machine due to osa. Because of claustrophobia and anxiety to the mask, I didn't use the machine. Two and a half months ago I ended up in the hospital. I was in shock, I had and have OHS and hypercapnia. Right before midnight I had type 2 respiratory failure and was intubated. My PcO2 was greater than 130. The following they tried a sbt to see if I could come off the intubation and I failed. The next day I passed and I was extubated. They put me on a bipap machine that night and the following morning my carbon dioxide levels were over 70. So they kept me another night. They tried all of the bipap machines they had before resorting to an avaps machine. On the avaps machine I did much better, so I got to go home. I am on an avaps machine along with oxygen, and also oxygen is fed into my machine. I would like to know more about the avaps machine and also on how to strengthen my lungs so that my breathing becomes stronger. Right now, it is too shallow. Thank you for reading.

[@user-yx7or5qw4u]

Lose more weight by diet modification. Avoid evening sweets, walk exercises or treadmill. You may also consult with a pulmonologist in your area. There are specialized dentists now that are custom fitting an oral mouthpiece to splint your airway open by positioning your tongue from blocking your windpipe.

[@zava9822]

So is this constant Pressure of 5 called inspiration pressure or expiratory pressure ?

[@WhiteboardMedicine]

It is the expiratory pressure, which is also sometimes referred to as the PEEP (positive end expiratory pressure)!

[@md2be300]

Hi 👋

[@WhiteboardMedicine]

Hello and thanks for checking out the video!

[@spencer4648]

😣 *promo sm*

[@mballer]

Iron lungs may be better.

[@flagmichael]

If they were, we wouldn't have CPAPs/BPAPs. They take a couple weeks to get used to but can be a life-changer. I experienced more energy, better attention behind the wheel, and no longer living in a fog.

[@mballer]

@@flagmichael What is your underlying condition causing your problem?

[@flagmichael]

@@mballer Obstructive sleep apnea (OSA): my airway sort of collapses when I go to sleep. It is the most common reason for needing these machines, affecting 10-15% percent of women and 15-30% of men. Obesity is a factor, but my wife complained about my snoring when I was chronically underweight, and sometimes my airway would close enough that I had to wake up and move my head to breathe again. She swore I sometimes started snoring before I laid down and a couple times I noticed I was actually doing that. Not all who snore have OSA but it is a common indicator.

[@WhiteboardMedicine]

This is a great summary! Couldn’t agree more!