RT Clinic : CPAP vs. BiPAP What is the difference?

[@patty1_2]

I am a BiPAP user for 2-3 years after using CPAP for over 10 years. Your video explained to me the difference. I am 64 years old. Your video educated me to press my Pulmonologist to manage me and my machine. I never awake refreshed. Thank you!!!

[@SocaliLea909]

Me either 2yrs cpap wake up with headache no diff still tired

[@nakoamajor8346]

I just graduated, and I can honestly say that thus far this has been the best explanation I have heard regarding this topic. You broke down the basics very nicely 👍🏾👍🏾

[@rtclinic]

Thanks Nakoa!

[@frankfromupstateny3796]

Very simple...everyone should be able to understand this guy and his talk. Cheers.

[@brittbratt__8362]

This helped me so much! I’m in mechanical vents this semester and you did great on this video to help me understand

[@estheranngestupa5772]

Im studying Respiratory Therapy :) this video help me as a student. Please do a video of Pulmonary Function Test and what are the underlying diseases that gives the different results of their PFT

[@samisabrin6591]

You are the right person that I was looking for

[@shelleyb8873]

Thank you so much. I have COPD and will be getting a BIPAP so I wanted to have an understanding of how it works. Now I do!!!

[@lucymike12]

Awesome ! I love ❤️ this! Thank you so much ! Can’t wait for the pharmacology videos !

[@emilysouth3599]

I watched this video to see what sorts of graphics you draw to explain these concepts. They look so much like the ones that I draw when teaching my internal medicine and family medicine residents these modalities. It's nice to know that I'm not completely off track on my in-the-moment drawings, and that our terminology in our explanations are similar. Thank you!

[@rtclinic]

I'm glad someone could understand my scribbles on the whiteboard. I think the pressure vs time waveform solidifies CPAP vs BiPAP for the learners almost every time. 😊

[@razchhhhh]

hello sir Jimmy.. I suggest you make a video on how to set up a mechanical ventilator using BIPAP and cpap mode..and also setting cpap machine using the cpap/bipap mode

[@tigerfish4628]

This was so helpful!! I've been trying to understand these concepts for a while and for some reason it just didn't make sense to me until you explained it. I like the use of the whiteboard as well. I draw out what you're doing and add it to my notes.

[@raymondfraley]

Thank you that was excellent. Really did answer my programming questions as a bipap patient

[@jorgegarfias4041]

Would you be able to make a video on how to use an IPV machine, also what it is indicated for, contraindications and how to manipulate the settings. Thank you Jimmy, really enjoying all your tutorials/lectures.

[@rtclinic]

I would love to, but I don't have an IPV machine at my facility. 🙁

[@AS-bp4fi]

This guy is awesome. Thank you for putting out this great content

[@leilagoerring804]

Just wonderful, I have been researching "types of bipap machines" for a while now, and I think this has helped. Have you ever come across - Peyichael Simplified Plan - (do a google search )? It is a smashing one of a kind product for discovering how to get rid of snoring and sleep apnea without the normal expense. Ive heard some amazing things about it and my co-worker got amazing success with it.

[@peterfslife]

0:24 Key word Here! REQUESTS!!! Bottom line is we have more videos! So here's a bunch of requests! Believe me! I'm good at this!!! I commented on one of your videos actually two of your videos yesterday, and one question was about NIF. Now you're gonna get several requests. You have done a video about Weaning from APRV. We'd like to see a video about weaning from conventional ventilatory support. We want a video where you simulate a NIF on the Drager ventilator. The Drager vents can do that as you know, You could be the patient by using a Mouthpiece, or even an Ambu/BVM mask. Like I said, I asked a question about NIF, nobody has been able to answer for me. There's a separate function as you know known as "Oxygen Therapy!" There's barely any videos explaining that. One from Drager's KZbin channel, but that was all that I could fine. Another video? If possible, and if You use the rotoProne in your hospital, maybe we'd like to see our Favorite KZbin RT, Jimmy, YES YOU, get in the bed! If the hospital would let you! These beds are so important now days, with COVID, and the ARDS that it causes! And maybe you should do a video ON GOOD TOPICS LIKE THE mETAnEB THERAPY SYSTEM, IF YOUR HOSPITAL USES THAT DEVICE! sEE i AM ALL ABOUT THE GOOD ADVANCED rt TOPICS. wHAT ABOUT A VIDEO ON THE airvo DEVICE? tHOSE ARE VERY COMMONLY USED IN HIGH FLOW THERAPY! aND WHAT ABOUT A VIDEO ON DISCUSSING THE ASPECTS OF iNHAILED nITRIC oXIDE! aS YOU KNOW iT'S COMMONLY USED ON iNFANTS IN THE nicu, AND SOMETIMES IT IS USED IN aDULTS IN THE icu! aND WHAT ABOUT A VIDEO ON the Cough Assist. You might use that for a patient who's come in and who's diaphgram is weak due to Guillain Barre, or maybe Muscular dystrophy! I turned my caps lock off, as I just realized it was on. But the cough assist would be a wonderful wonderful topic! There are so many other topics, but that list I just gave you should be enough for today! BUT WE DO WE REALLY DO, want more videos!

[@minalbhatia8926]

Thanku so much.....this is so helpful video to understand the difference between CPAP n Bipap...

[@JMcN76]

Excellent and easy to understand explanation. Thanks!

[@fionarob8371]

Great video!!! I'm taking critical care in nursing school now but couldn't find a good video that explains the difference between CPAP and BiPAP. Thanks for your time!!! Two questions: 1. When you increase IPAP in BiPAP, do you try to increase the positive inspiratory pressure so that the patient can breathe in more air (more tidal volume), but how does it help to get rid of more CO2? 2. Would you prefer BiPAP over CPAP? if you would, in what kind of circumstances? Thanks!

[@rtclinic]

Thanks for your comment! BiPAP vs CPAP is one of the top questions for many nurses.

[@rtclinic]

#1. When an IPAP is increased, the PIP is also increased. Your set IPAP is usually the PIP.

[@rtclinic]

#2. CPAP for obstructive sleep apnea or a patient with poor oxygenation w/o a ventilatory issue. BiPAP for central sleep apnea or patients with ventilatory et oxygenation issues. If a patient is indicated for CPAP, but cannot tolerate the continuous pressure...I'll try BiPAP because it sometimes is easier for the patient to tolerate.

[@fionarob8371]

Jimmy McKanna - RT Clinic thank you so much!!! Great explanation! :)

[@V1ntageheart]

Really appreciate you’re videos!! Thank you

[@harryraj2067]

Very nicely explained differences between CPAP & BiPAP

[@NJAveraGeStiFf]

Volume sucks need a mic. Wish I could watch more. Hit me if u made a updated video

[@cbabe1]

I am enjoying your videos. Will you do a video on suctioning tracheostomy and ET tubes?

[@stunnerdoc]

You mentioned cycle on its own, the correct terminology is “machine triggered”. Cycling is termination of a breath

[@rtclinic]

Thanks for the correction.

[@sakrobotu]

Thanks for sharing your videos with us.Can you please make a video on gastrostomy tubes?

[@rtclinic]

Unfortunately, I do not know enough about gastrostomy tubes to produce a 10 second video 🤣

[@pawansingh1642]

Plz make vedio on ventilator settings

[@Suzi_P]

I love your videos so much. They are so helpful and you are awesome

[@ChrisPolg]

Paramedic here. Thanks for this video.

[@louisianastrong7698]

Did you ever make mistakes as a Basic?

[@ChrisPolg]

GramGirl Never. Perfect EMTs make Perfect Paramedics. 🙃

[@fishingsouls4christceoofgi614]

RT clinic Binge watch!🧡

[@Flaw202]

I'm currently working with my son's physicians and RTs in order to liberate him from the ventilator and transition to breathing on his own. He was born 3 months premature and has been on the vent since birth; with two failed attempts of transitioning to the CPAP. The first attempt lasted about a week before re-intubation. Doctors said it was due to a heart murmur. Two weeks after the heart murmur was closed the transition lasted all of 3-4 hours before re-intubation. Do you think the bipap would be considered a better form of liberation from the ventilator

[@rtclinic]

We don't commonly do bipap on neonates. Sounds like the tram is right on track. CPAP trials and high flow oxygen are commonly used to wean off a vent in the NiCU

[@serendipitypfl3027]

awesome explanation, visual and practical!

[@johnanderson8096]

Best video on the subject... Thank you!!!

[@pramodgaikwad5500]

It was amazing. Keep up the great work bro.

[@gracewaithaka9382]

Thank you! Well explained

[@aardvarkmcgillicuddy]

Can 20 years of CPAP cause hyperinflation? I feel like I've been fighting my machine for along time, but getting to see someone about it has been nearly impossible since COVID.

[@rtclinic]

That's interesting... physiologically you would have some hyperinflation after 20 years. Sounds like you need another sleep study or a new machine. Try a clinic associated with a hospital, it might allow you a quicker followup appt with a specialist.

[@bettysmith4527]

THank you for the video! Just wondering when you should change rise time and cycle off time? Our vent/bipap/cpap on the ambulance auto sets them at 3 and 25%. Also if you do have a CHF Patient are you better off just putting them on CPAP as opposed to BiPAP.

[@rtclinic]

The only time I change rise time is when a patient is tachypneic and requiring a high peak flow. I will turn the rise time down at that point. Technically CPAP should be the mode of choice for a hypoxic CHF/pulm edema patient, buy if they cannot tolerate the continuous pressure, I would try bipap

[@bettysmith4527]

@@rtclinic thank you!

[@visionhawk4403]

I have been diagnosed with severe OSA for a long time and they always put me on a CPAP. I recently did another sleep study and this time they put me on BiPAP still with the diagnosis of severe OSA. The pulmonologist told me that they tried the CPAP first and it wasn't helping so they put me on a BiPAP. My top number is 19 and I can't remember what my other number is, something like 12 or so. It feels really weird compared to the CPAP that I've been using for years and years. When I exhale, I can't feel any pressure at all. My question is, is the BiPAP really better for sleep apnea? My doctor seemed to think so, but it still feels really weird. I'm getting good sleep, but going to sleep is still kind of hard. I don't know if I'm just having to get used to the BiPAP or if someone got something wrong. I could really use some advice.

[@rtclinic]

Hello Byron, The ineffectiveness of your CPAP at combating your severe OSA is the reason the MD changed you to BiPAP. Most home unit CPAP machines will do both CPAP or BiPAP, so the change is pretty easy to accomplish. BiPAP is more responsive to your breathing pattern at night. It will fluctuate up and down as you breath and give you the high pressure when you take a breath in and lower when you breath out. The hope would be...it would open your airways during your inspiration and splint them when you exhale. BiPAP must have worked during your last sleep study. From other patient responses, BiPAP does feel different and actually feels more comfortable to most others at high pressures. Please keep me up to date. If you start waking with the classic OSA signs (splitting headache, blood shot eyes, daytime sleepiness) be sure you let your pulmonologist know about it.

[@frankfromupstateny3796]

Hey Byron,....think of it like this sir,....you're still having the pressures when "you" begin the inhale....but not...when you're not..or at least...not at the same high level or amplitude as CPAP...that's the major difference. Your own diaphragm is acting to "initiate the inhalation/breathing in" of air/oxygen.

[@andreacook7999]

Love your videos! Thank you!!

[@fatialaoui3016]

Thank you so much! it helps me a lot

[@gerardhaubert8210]

Why do I have so much trouble exhaling with my under nose mask? I’m using a ResMed Astral 150 vent. Don’t know the setting, but was told they are very low. Am I doing something wrong or is it something else?

[@rtclinic]

It could be few different things.. 1. a high cpap level. 2. Something occluding the expiratory limb of your circuit. 3. The trigger (sensitivity) is set too high and it doesn't sense your exhalation correctly.

[@anomikak1062]

What does he mean "You don't want to put someone who is apneic on a biPAP."? Does he mean someone with Central Apnea as oppose to OSA. It's the only think i can think of because it seems to contract what he is saying. To me: ap·ne·ic (ap'nē-ik), Related to or suffering from apnea. So in one sentence he says most people who are diagnosed with OSA are now automatically on biLevel, then in the next says you don't want to put someone who is apneic on a biLevel. ?????? The is clearly smart, so he must have a different definition for Apneic then me and every medical dictionary on the web. So i looked it up and found this: "BPAP could worsen central sleep apnea in people with heart failure. " So, help me understand here. Is this what he is saying: "Most people with OSA are started on biLevels, but you shouldn't put someone with Central Sleep apnea on a bilevel."?

[@zubaerzamil]

How we determine Ipap value and Epap value for Bipap machine for a patient.Could you share with me the procedures?????Thanks for your cooperative response.

[@rtclinic]

IPAP is the highest pressure and it should be a setting on the BiPAP. EPAP is the lowest pressure.

[@stygianphantasm8761]

What is better for aerophagia? A CPAP or BiPAP?

[@rtclinic]

In my experience, BiPAP is more tolerable in these cases. Thanks for the question!

[@Romulan112]

How do you determine the proper I Time for a BiPaP? The RT set the bipap for 16/6 ti=1.0 Patient was breathing in 40's. I said to set the I time at .70. He disagreed.

[@rtclinic]

I like how you are thinking...😁👍 With NIPPV the i-time is only used if the patient is breathing at the same rate set on the BiPAP. Since it is used to augment their spont volume the patient will determine the i-time. Rise time can be changed in this case. Decreasing the rise time should increase patient comfort in this situation. Great question!

[@morganfong6029]

Thank you.you explain very well.

[@michellekraslow1085]

that was really helpful!!

[@fionazerbst5771]

I have sleep apnea with nocturnal seizures and therefore have mixed apneas. My CPAP is causing respiratory alkalosis despite being on the low setting of 7. Sleep clinic has suggested I try a BiPAP for a few nights. Is this likely to help? I always thought BiPAP was more for people with too little oxygen in their blood. My latest blood gas test is: PH 7.567, pC92 21.8, p02 113.11.

[@rtclinic]

Hello Fiona, Switching to BiPAP will likely synchronize your breathing with the fluctuation in pressures. In the acute care setting, BiPAP is used mainly for hypo-ventilation issues, which you definitely do not have :) . In the home, it can also help with comfort and synchrony during sleep. If it was me, I would give it a try for a couple weeks and see if you feel better in the morning.

[@fionazerbst5771]

@@rtclinic Thanks so much for replying. I want to remain compliant as I had high BP, high fasting glucose and cardiac arrhythmia before my sleep apnea was diagnosed. The CPAP has made a huge difference, but the respiratory alkalosis makes me shake all the time. I hope the BiPAP will make a difference. Also, very tired of painful blood gas tests! Very interesting video, by the way.

[@fionazerbst5771]

@@rtclinic Am trying to use the BiPAP but struggling. It does not work with my natural breathing rhythm- seems to blast me with air every few seconds, then take all the oxygen away so I can't inhale. Sleep clinic told me the settings are automatic and it will adjust, but that doesn't seem to be happening?

[@gamingwithmazeman2030]

@@fionazerbst5771 I know your message was a long time ago, but hopefully you see this. I had the BiPAP on the lowest possible setting and I couldn't do it because it would cause me to panic! When I exhaled and had to fight against what I called 'the leaf blower' it was just too much! Unfortunately, I had to return it. Hopefully my apnea doesn't get worse... Take care!

[@trieuenterprise]

Can you do a video on AHI?

[@dheer7777]

My basic queries:(as per my imagination :P) As there is CO2 retention - the problem lies during expiration ... hence CPAP shld be used as during expiraton airways are kept open fr CO2 to washout ...likewise .... problem with oxygenation lies as a part of inspiration .... hence it requires greater pressure during inspiration (so IPAP?) EG.If there is sm fluid in alveoli due to heart failure , more pressure is required to get through the fluid and in capillaries right? so pressure is required mainly during inspiration.... This is my dilemma ... please help me understand better ...

[@rtclinic]

Here's how I remember it. Mean airway pressure is the key to oxygenation. Many factors and settings change MAP, PEEP makes the most direct change to the MAP. CPAP also directly increases MAP. Ventilation is caused by any factor or setting that increases the pressure from the baseline. The larger the fluctuation from the baseline, the more CO2 will be exhaled.

[@frankiehill2079]

How do I breath out co2 when I have a constant air in pressure? I see and feel no air escaping From my full face mask. Am I breathing my own out breath?

[@rtclinic]

There are two options for exhalation. 1. Small ports in your mask. 2. A port in the circuit. You'll have to have one of the two options.

[@olivertabag2210]

Nice video. if the patient is only hypoxemic but the machine we have is bipap, can we set the pressure of ipap:epap the same ex 10/10

[@rtclinic]

Yes. Great thinking! If your Bipap will allow for an IPAP and EPAP of 10cm H2o, that would be perfect. What type of machine do you have?

[@tourstarproductions2150]

Excellent video! Great work, also little thing, i think your ABG values example, would actually be "noncompensated" (below pH value) rather than uncompensated (above pH value), but id have to check my notes to confirm that

[@rtclinic]

Thanks for the comment. To be honest, I didn't know there was a difference between uncompensated and non compensated. I'm going to have to research that myself😁

[@morganliaw2968]

I thought we usually remove more co2 by increase rate, how does increase volume/ipap removes more co2?

[@rtclinic]

Rate is the most effective way to lower CO2 on invasive ventilation (mechanical ventilation). In the case of non-invasive ventilation, increasing the rate usually causes asynchrony between the patient and the machine. NIPPV augments the spontaneous tidal volume well, but does not do well at adding breaths per minute. Many clinicians will increase rate on NIPPV to improve hypoventilation. Next time, suggest an IPAP change and watch the chest excursion go up and the CO2 go down 😆. Thanks for the question!

[@phillyb4588]

I thought EPAP blew off more CO2 not iPAP ...but u are saying I increase the IPAP to decrease co2 and increase pap to increase o2?

[@rtclinic]

That is correct Philly B!

[@luzmaalcaraz]

Good video. Used subtitles since the sound is very low.

[@rtclinic]

I recently bought a mic. I hope this shouldn't be a problem in the future.

[@calebtoyo7316]

Great stuff

[@islammmi]

You made it so simple

[@ronaldgoodwin8549]

was on cpap than went to bipap, now I have a headache, was it caused by bipap??

[@rtclinic]

Did your lower number EPaP change from your CPAP setting?

[@morganliaw2968]

Does epap pressure adds up on the normal physiological peep?

[@rtclinic]

That's a very good question! I believe EPAP is separate from physiological PEEP. EPAP is applied pressure during the entire exp cycle and PEEP is only applied at the end of expiration. Physio PEEP is more affected by glottal closure, so I wouldn't add the two values for a total PEEP. --Just my thoughts on the topic. Some instructors may see it differently.

[@phillyb4588]

pharm awesome , can u do chest tube drainage stuff

[@sinclair657]

Thank you

[@mercuryhg8]

Sir kindly improve audio quality.

[@michaelarnold4284]

My doc. Moving me from cpap to bipap pressure of 24.

[@rtclinic]

Bipap would have a two pressure setting instead of one. Changes from bipap to CPAP are usually triggered after an updated sleep study or to improve patient comfort.

[@natturner1542]

It would be nice to show pictures ! Like for regular people like myself.

[@rtclinic]

Nat, I can add some pics. Do you want waveform pics or pics of the machines?

[@natturner1542]

@@rtclinic Machine pictures.

[@rickturner2757]

better audio please

[@Doneman84]

The problem with these videos is that they don’t actually clearly explain the difference well to begin with. They confuse the topic by discussing respiratory pathologies which are in themselves complicated. Explain cpap and bi pap through the mechanics of breathing NOT as to how they are helpful / relate to certain respiratory pathologies.

[@rtclinic]

Good assessment. I probably should shoot another video for this one in the future.

[@nikostzanakis6900]

Your ABGs example is completely wrong as PaCO2=45 Torr and HCO3=24 mEq are non-valid coexistence along with a pH of 7.27... Your pH should be 7.35 otherwise your analyser's sensor did error measurement....

[@rtclinic]

Nikos, Thanks for your comment! The PaCO2 is 65 torr, but I can see how it looks like 45 in the video. Like most clinicians, my penmanship needs some work. 😄

[@nikostzanakis6900]

Thnak you for the response @@rtclinic ..... however even with PaCO2=65 the cCHO3 must be 30 mEq in order to correspond in a pH of 7.27..... or if you leave the cCHO3=24 mEq then the pH should be according to appropriate equations 7.15.... only these 2 set of measurements have internal validity otherwise the machine performs wrongly in that instance... Anyway your presentation is perfect for the begginers...

[@محمودخميسعبداللطيف]

Thank you I am from Egypt Please try talk slowly the next time But thank you very much

[@rtclinic]

I'll work on speaking slower in the future Houda. 😁

[@lisaolson3658]

I can barely hear you

[@GB-vo7ws]

Turn up your volume 💀

[@southernmedicalequipment3650]

cant hear you

[@rtclinic]

I have since purchased a mic.. sorry about the sound