What are the roles of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) in the treatment of chronic obstructive pulmonary disease (COPD)?

Updated: Aug 15, 2019
  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

These devices help to decrease the work of breathing and maintain positive end-expiratory pressure (PEEP). In patients with chronic obstructive pulmonary disease (COPD) who are in extremis, CPAP or BiPAP may be attempted prior to intubation. This can be started in the ED and continued for several hours in the hospital. Usual recommended settings are an inspiratory positive airway pressure (IPAP) of 10 cm water and an expiratory positive airway pressure (EPAP) of 2 cm water, with further adjustments based on the individual. This is contingent on the patient's ability to withstand the mask. This treatment is not a substitute for intubation; rather, it is a means of trying to avoid intubation. Keep in mind that altered level of consciousness is a contraindication for BiPAP, so carefully examine patients to determine appropriateness of its use.

Heliox is an additional strategy that can be attempted prior to intubation. Whether Heliox or CPAP is used will depend on the individual patient and local hospital availability. Again, like several other therapies mentioned in this article, study results both for and against Heliox have been published. The current summation of that literature indicates that Heliox may actually decrease the work of breathing while the patient is breathing the mixture, but its effects are not long lasting once it is removed. The proper mixture of the gases and the ability to deliver enough oxygen to the patient are also issues.


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