BiPAP with Chest Physiotherapy
BiPAP with Chest Physiotherapy
BiPAP with Chest Physiotherapy
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<strong>BiPAP</strong> <strong>with</strong> <strong>Chest</strong> <strong>Physiotherapy</strong>
IPPV<br />
Improve arterial blood gases<br />
improve ventilation<br />
reduce the work of breathing<br />
Torres 1960,Emmanuel1966, Sukumalchantra<br />
1965
NIPPV<br />
Effective treatment for chronic and acute<br />
respiratory failure in pts <strong>with</strong> restrictive or<br />
neuromuscular disorders<br />
Bach 1987,Caroll<br />
1988, Elliot 1990<br />
In chronic respiratory disease can improve<br />
gases and fatigue in acute or chronic state<br />
Bott 1991,Conway 1991 Elliot 1990
Acidotic pH blood gases - poor prognosis -<br />
early intervention important to decreases<br />
mortality. Start NIV early.<br />
Mikelson 2000
NIPPV<br />
Better pH<br />
better survival<br />
less breathlessness<br />
better QOL and sleep<br />
no increase in nursing care<br />
Bott 1992
NIPPV<br />
18 CF pts <strong>with</strong> atelectasis<br />
10/18 (56%) resolution <strong>with</strong> NIPPV<br />
77% increase FEV1<br />
Costantini 1999<br />
Bridge to transplant<br />
Stevens 1990 and numerous authors
NIV in CF<br />
13/14 imp gases Restrick 1993<br />
18/22 dec hospital stay<br />
Udwadi 1992<br />
46 pts desc outcome Davis 1978<br />
12/12 imp FVC & PaO2 at 3/12 Hill 1998<br />
4pts imp gases& QOL 18/12 Piper 1992<br />
6pts NIV cf low flow O2 NIV imp gases<br />
Gozal 1997
NIV in CF<br />
8 severe pts imp gases and dec WOB<br />
Granton 1998<br />
14 pts no change gases or survival but dec<br />
hosp stays and inc function<br />
Benhamen 1997
SUITABILITY<br />
Hypercapnic resp failure<br />
normal bulbar function<br />
ability to clear secs<br />
GO tract functioning<br />
ability to cooperate
Contraindications<br />
Pneumothorax<br />
haem instability<br />
bullous lung disease<br />
epistaxis<br />
? Inability to remove mask
ADVANTAGES FOR CHEST<br />
CLEARANCE<br />
More responsive to Rx<br />
air behind secs<br />
less tired<br />
tolerate Rx better as less breathless
Muscular dystrophy weaning from<br />
conventional ventilation<br />
recurrent L lung collapse in 2yr old <strong>with</strong> L<br />
hemiplegia<br />
acute atelectasis / acutely unwell in CF<br />
terminal care in CF
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