RT-08 · Initiation & Modification

Noninvasive Ventilation, CPAP & BiPAP

Who benefits, who must be intubated instead, how to set IPAP and EPAP, and how to tell in two hours whether NIV is working.

~21 min read3 concept sections·4 questions with rationale

What you'll be able to do

  • Distinguish CPAP from bilevel indications
  • Apply absolute contraindications to NIV
  • Titrate IPAP and EPAP to the physiologic problem
  • Recognize NIV failure before it becomes an emergency intubation
Concept breakdown
01

CPAP versus bilevel — the physiology decides

CPAP fixes oxygenation and preload. Bilevel adds ventilation. Pick by whether the CO2 is the problem.

  • CPAP: obstructive sleep apnea, cardiogenic pulmonary edema, and atelectasis — one continuous pressure that splints airways and reduces preload and afterload.
  • Bilevel (IPAP/EPAP): hypercapnic failure — COPD exacerbation, neuromuscular weakness, obesity hypoventilation. The pressure difference is the tidal volume.
  • Strongest evidence: COPD exacerbation with pH 7.25–7.35 and cardiogenic pulmonary edema. Both reduce intubation and mortality.
  • Typical start: IPAP 10–12, EPAP 4–5 cm H2O; increase IPAP by 2 for CO2 and EPAP by 2 for oxygenation.
At the bedside

IPAP minus EPAP is the ventilation. Raising both equally does nothing for a rising CO2.

Practice quiz

Check yourself before you read the rationale.

Question 1 of 1

A COPD patient on BiPAP 12/5 has a repeat gas showing pH 7.28 and PaCO2 68 (previously 7.27 / 70). Mental status is unchanged. The best adjustment is:

Practice questions

Answer first, then read why the distractors fail.

Question 1

A COPD patient on BiPAP 12/5 has a repeat gas showing pH 7.28 and PaCO2 68 (previously 7.27 / 70). Mental status is unchanged. The best adjustment is:

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2 more concept sections, 3 more questions, and the exam-day playbook for this module.

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