BiPAP and CPAP Overview

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The following course content

This course is an overview of noninvasive ventilation (NIV) methods biphasic positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP). This course will provide an overview of BiPAP and CPAP basics, administration, contraindications, considerations for specific patient populations, precautions, patient education, and management. Learners will explore the purpose of these therapies and ways to assess BiPAP and CPAP use and success in patient care. This course is for LPNs, RNs, and APRNs.

Introduction   

When hearing the phrase noninvasive ventilation (NIV), what comes to mind? What do you think of when you hear of biphasic positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP)? If you’re a nurse, you’ve heard about NIV at some point in your nursing studies and career. Maybe even before nursing school, you might have seen some people with devices to help them breathe in your family or community. 

Presently, patients seek guidance and information on various health topics from nurses, including BiPAP and CPAP use. The information in this course will serve as a valuable resource for nurses of all specialties, education levels, and backgrounds to learn more about BiPAP and CPAP therapy. 

Defining Noninvasive Ventilation (NIV) 

Noninvasive ventilation (NIV) is a medical intervention that involves oxygen delivery to someone’s lungs with positive pressure. This is noninvasive compared to other oxygen delivery methods, such as endotracheal intubation and manual oxygen delivery, because of the lack of mechanical involvement directly into the lungs.  

Common examples of NIV include biphasic positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP). Both BiPAP and CPAP are used in a variety of clinical settings for various patient needs, such as critical care nursing, emergency room nursing, and rehabilitation care nursing. With the rise of technology and remote patient monitoring, thousands of patients use BiPAP and CPAP machines from their own homes with minimal nursing intervention.  

Because both BiPAP and CPAP can be used for short or long durations (as little as a few days to a lifetime), nursing care and patient monitoring must be followed to ensure that patients are receiving appropriate nutrition, oxygenation, pain control, and improvements in health and quality of life (1,2,3,4).  

Defining the Difference Between BiPAP and CPAP 

A BiPAP, also known as a BPAP, is the most commonly used type of NIV in the United States and provides a consistent level of positive end-expiratory pressure (PEEP) in addition to positive inspiratory pressure. The ranges for both pressures can vary depending on the patient’s status, age, and equipment itself. 

BiPAP machines are common because of their ease of use among clinical staff, minimal discomfort for patients, cost, accessibility, and clinical indications. CPAP is a type of NIV that is less commonly used than BiPAP but still very popular and well-used. CPAP machines deliver positive airway pressure maintained throughout the respiratory cycle during both inspiration and expiration.  

Both BiPAP and CPAP machines provide continuous set pressure when a patient is inhaling. BiPAP machines have lower set pressures during the exhale respiratory phase, whereas CPAP machines relieve pressure during the exhale respiratory phase. BiPAP machines have different pressure settings for both inhaling and exhaling. CPAP machines tend to be more cost-efficient and portable, whereas BiPAP machines can be more costly and not as portable (1,2,3,4,5,6).  

A patient’s clinical condition, response to NIV therapy, age, insurance, health status, and other factors determine the need and length for either BiPAP or CPAP use. Because of various factors influencing CPAP or BiPAP duration, dosage, and type, monitoring of patients on CPAP or BiPAP is essential. This is especially true since the majority of patients receiving BiPAP or CPAP can breathe on their own, but have intermittent, inadequate breathing that requires additional mechanical intervention. Because of each patient’s situation, it is important to make sure they are aware of the role of BiPAP and CPAP machines and educated on the risks and benefits (1,2,3,4,5,6).  

BiPAP and CPAP Prevalence 

The exact prevalence of BiPAP and CPAP use is not known, as BiPAP and CPAP usage can vary widely in several healthcare settings. No longer are days when BiPAP and CPAP machines are limited to emergency or acute care settings. Several patients use these devices at home, when traveling, in outpatient care centers, nursing homes, and more. It is estimated that millions of adults use CPAP machines at home annually, with similar estimates for BiPAP use. 

CPAP and BiPAP machines are used by all age groups, from neonatal to geriatric populations. CPAP and BiPAP machines are also used by patients with physical or intellectual disabilities. While CPAP and BiPAP machines can be managed by the patient themselves, oftentimes, many patients using a CPAP or BiPAP machine have a caregiver, such as a parent or spouse, who can assist with their machine and monitoring as well. In general, most acute care settings, hospitals, rehabilitation care centers, and long-term care facilities have CPAP and BiPAP machines available for patient use. It is important to note that CPAP and BiPAP machines are available via prescription only, which can also cause discrepancies in true prevalence in various inpatient and outpatient settings (1,2,3,4,5,6).  

What Causes People to Be on BiPAP or CPAP? 

Patients can be on either BiPAP or CPAP for many reasons. People are not typically on both machines, as both serve different purposes regarding the oxygenation needs for a patient. For instance, neonates might be on BiPAP or CPAP if they are born prematurely and unable to maintain adequate oxygenation upon delivery. Patients can be on BiPAP for various health conditions, such as respiratory failure, circulatory failure, asthmatic flare-ups, chronic pulmonary obstructive disease (COPD), neurological conditions, obesity hypoventilation syndrome (OHS), and other similar conditions. Patients can be on CPAP for various health conditions, such as sleep apnea, sleep-related breathing disorders, and other respiratory conditions.  

A typical patient inhaling and exhaling independently will not need BiPAP or CPAP assistance. However, suppose a patient has experienced sudden trauma, such as a motor vehicle accident (MVA) or physical injury. In that case, they might be on CPAP or BiPAP for a few days to weeks until their condition stabilizes. Another patient might be on CPAP or BiPAP for the rest of their lives if they have chronic asthma flare-ups, sleep apnea, or other breathing complications. Because every patient scenario is unique and BiPAP and CPAP machines are becoming more popular in long-term and outpatient settings, frequent, accurate monitoring and assessment are essential. It is also important to note that a patient is never on either BPAP or CPAP machines, as patients are on either machine depending on their clinical situation (1,2,3,4,5,6,7).  

While there are many reasons for a patient to be on CPAP or BiPAP machines, it is important to note that CPAP or BiPAP is often not a first-line treatment option for breathing concerns, as many other interventions can be performed as well, such as pharmacological options, endotracheal intubation, and more. However, the rise of CPAP and BiPAP machines has allowed for more non-pharmacological, non-invasive methods of helping patients breathe, allowing for fewer drug-drug interactions and possible improvement in the quality of life and care for the patient. CPAP and BiPAP machines are not meant to substitute for breathing if a patient cannot ever breathe on their own.  

Patients who are on either CPAP or BiPAP machines will need to have their comfort, nutrition, pain, and respirations regularly assessed, as chronic use of any device can cause complications as well as benefits for the patient. In some situations, CPAP and BiPAP machines are often a last-resort medical intervention given cost, patient discomfort, contraindications, and complications (1,2,3,4,5,6,7,8). 

While many patients can be on either BiPAP or CPAP machines, certain contraindications for use of either include extensive facial trauma, patient unwillingness to use these technologies, recent surgical interventions to the patient’s face or esophagus, facial burns, severe nausea or vomiting, patient unresponsiveness or decreased loss of consciousness, air leak syndrome, or a patient with excessive respiratory secretions.  

BiPAP and CPAP machines do not have boxed warnings, but because of their varied settings and various uses for patient care, monitoring of patient’s health on these machines is essential (1,2,3,4,5,6,7).  

What Are the Various BiPAP and CPAP Options? 

There are several Food and Drug Administration (FDA) approved BiPAP and CPAP machines on the U.S. market. That said, many healthcare organizations contract with manufacturers, so at your workplace, it is important to familiarize yourself with the BiPAP and CPAP machines you will encounter. In addition, BiPAP and CPAP machines use straps and tubes that can influence patient skin sensitivities or trigger allergic reactions, so it is important to understand the materials each machine uses and the patient’s allergy history as well. 

Consider your patient’s needs, allergies, facility protocols, patient condition, respiratory status, medication administration routes, machine settings, and overall patient progress when assessing for BiPAP and CPAP use and progress. Even though BiPAP and CPAP machines have existed for the past several decades, recent advances in technology have made BiPAP and CPAP use more acceptable in several settings (1,2,3,4). 

How and Where Are BiPAP and CPAP Used? 

As mentioned above, BiPAP and CPAP machines are used in several inpatient and outpatient settings presently. While many people can initially start using BiPAP or CPAP machines in an acute care setting, many times, patients can also start using CPAP or BiPAP machines in their own homes after clinical evaluation. BiPAP and CPAP machines are used similarly in the sense that they need to be plugged into an electric source, and a mask must be worn correctly on a patient’s face during the duration of use. If there is no electric source, the machines will not work. In emergencies, a BiPAP or CPAP machine can be used with a generator or large portable battery.  

After the machine is plugged in, the settings on the BiPAP or CPAP machines are determined by the healthcare provider depending on the patient’s health, machine capabilities, and overall patient need for oxygenation. Some patients will be on CPAP machines only when they sleep. Both types of machines also have a filter, and making sure that the filter is working and placed correctly is essential. Some patients will be on BiPAP machines for a few hours a day. Some patients will be on either machine for a few days or can range for the rest of their lives.  

Because of the wide usage of BiPAP and CPAP machines, education on patient safety, mechanical safety, and patient health is essential. Once the mask is put on for either machine, the health care team should adjust either machine for the appropriate settings. If a patient is using a BiPAP or CPAP machine at their own home, the health care provider should have written and explained clearly the settings for which they want the patient to use (1,2,3,4,5,6).  

When a patient is on the BiPAP or CPAP machine, they can continue to breathe as they normally would, but they are in their bed or couch position. Patients cannot exercise, cook, clean, or be mobile when either device is working. As a result, many patients read, knit, or sleep when they are on these machines. With the rise of home health and telehealth interventions, many patients can receive either BiPAP or CPAP machine care in a hospital setting, then transition to administering BiPAP or CPAP care at home with a home health nurse and follow up with health care services as needed.

CPAP use is more common at home than BiPAP use, given the cost, patient need, and availability. In some situations, patients and caregivers can even adjust and self-manage their BiPAP or CPAP machines at home alone, depending on the patient’s health condition, comfort, and health history. Because of the growing prevalence of NIV technologies outside of acute settings, it is important to keep in mind the role of patient education and nursing care in BiPAP and CPAP administration and patient care management (1,2,3,4,5,6,7).  

What Are the Clinical Criterium for Being on BiPAP or CPAP? 

Clinical criteria for BiPAP or CPAP administration and use can vary depending on facility protocol and NIV guidelines. That said, clinician judgment and patient consideration should guide the need for BiPAP or CPAP use, as both are used for various reasons and for varied durations. While NIV technologies are becoming more popular, neither BiPAP nor CPAP are routine medical interventions, as these are costly medical devices that require patient education, monitoring, and intervention. In addition, being on a BiPAP or CPAP machine presents several risks, and risks versus benefits must be considered for the patient.  

Clinical criteria for being on BiPAP or CPAP would be to ensure the placement of the mask and machine equipment and ensure that the patient is comfortable and willing to use these devices. Also, if a patient is going to use either device in an outpatient setting, patient lifestyle factors and ability to self-manage a BiPAP or CPAP machine is something to consider as well (1,2,3,4,5,6).  

What Are Some Side Effects and Complications of BiPAP and CPAP? 

While BiPAP and CPAP are essential medical interventions for many patients, BiPAP and CPAP machines have several possible side effects and complications. The most immediate complications of BiPAP and CPAP machines can be allergic reactions to the materials in the straps or face masks, altered breathing rates, pain, discomfort, skin irritation, inadequate oxygenation, and machine malfunctions.  

If allergic reactions or machine malfunctions are suspected, the nurse should stop the BiPAP or CPAP immediately and assess the patient. Given the wide range of possible and severe side effects and complications of BiPAP and CPAP use, careful monitoring of a patient’s health and condition is essential. While some patients will have no symptoms initially on either machine, others can develop symptoms over time, especially if they use these machines chronically.  

While there are no established protocols on serum lab values or imaging to monitor patients on BiPAP or CPAP machines, it is essential to check with your facility’s protocol regarding the frequency of assessments and monitoring for patients receiving BiPAP or CPAP machines (1,2,3,4,5,6,7).  

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What is the Average Cost of Being on BiPAP or CPAP?

Cost for BiPAP or CPAP administration, including replacements for the filters, masks, and tubes, can significantly vary depending on the type of machine, insurance, machine strength and frequency, duration, and other factors. CPAP and BiPAP machines are often expensive medical interventions, but for many patients, it is essential care and possibly the only way for some patients to receive treatment given their health situation. Cost is among a leading reason why many patients cannot maintain their medication and healthcare regime, especially if CPAP or BiPAP use is recommended in an outpatient setting. If cost is a concern for your patient, consider reaching out to your local patient care teams to find cost-effective solutions for your patients (1,7).

How Can Patients Self-Manage Being on BiPAP or CPAP?

Depending on the nature of BiPAP or CPAP administration, patients may have either machine initiated in an acute setting, such as a med-surgical unit, and then be discharged to home care with a BiPAP or CPAP for home use. In addition, either BiPAP or CPAP can be used for patients with prolonged hospitalizations as well, allowing patients time to become familiar with their machine’s administration and the entire BiPAP or CPAP process.

While patients in acute settings monitored by nurses and other health care professionals do not need to self-manage their CPAP or BiPAP, patients can be aware of possible BiPAP or CPAP complications regardless of their setting. Patients can be aware of possible symptoms to alert for medical attention, such as trouble breathing, chest pain, facial pain, confusion, headache, numbness, redness around the straps, debris in the tubing, and fatigue.

Patients administering their own CPAP or BiPAP machines at home should be aware of ways to self-manage these machines and settings at home, including having their caregivers or loved ones be aware of CPAP or BiPAP administration as well. Common ways for patients using BiPAP or CPAP machines at home to self-manage themselves include having access to consistent electricity or an emergency electric source like a generator, having a clean area to set up and use BiPAP and CPAP supplies, having a support system, maintaining routine follow up care with their health care providers, and having access to a local emergency room in case of any BiPAP or CPAP complications (1,2,3,4,5,6,7).

In addition, patients can self-monitor their breathing, sleep patterns, oxygenation, pain, hydration, and overall health to detect any early changes or BiPAP or CPAP complications. Since these machines require proximity to the patient, making sure the area next to the BiPAP or CPAP is clean is essential. Patients and caregivers can also be educated on infection reduction techniques, such as hand washing, mask-wearing, disinfecting surfaces, organizing additional supplies like tubes and filters, and more (1,6).

What Are Alternatives to Being on BiPAP or CPAP?

Alternatives to being on BiPAP or CPAP can greatly vary depending on the patient’s health and presentation. For most patients, the alternative to BiPAP or CPAP is being on room air oxygen, breathing on your own, or initiating endotracheal intubation in severe respiratory situations. Other options can also be considered with the aid of a respiratory therapist and other medical consults (1).

What Happens to Patients Who Do Not Have Access to BiPAP or CPAP When Clinically Necessary?

Depending on the nature of the patient’s condition requiring BiPAP or CPAP use, patients who do not receive adequate BiPAP or CPAP use will experience inadequate oxygenation. Depending on the patient’s severity, this can lead to impaired oxygenation, causing organ failure, respiratory depression, and death. Oftentimes, patients who were using BiPAP or CPAP prior and then suddenly stopped using their machine can experience shifts in oxygenation and have further health complications. As a result, it is important to educate patients on the importance of consistency in their treatment regime and the risks and benefits of using either machine (1,7,8).

BiPAP and CPAP Special Considerations for Specific Patient Populations or Conditions

Given the wide range of uses for BiPAP and CPAP and use in various patient populations, there are special considerations to be aware of for patients of certain age groups or with certain health conditions.

BiPAP or CPAP Use and Considerations in Neonate Populations

BiPAP and CPAP use are commonly seen in neonatal intensive care units (NICUs) across America. Neonates receiving BiPAP or CPAP care often are on either machine as a result of respiratory distress syndrome (RDS), preterm development, or other neonatal-developmental complications. Neonates in the NICU often have to breathe independently without BiPAP or CPAP use before being discharged to their parents.

Sometimes, neonates with extreme respiratory conditions can be discharged with a neonatal BiPAP or CPAP machine, but oftentimes, that is not clinically indicated unless there is an emergency in the NICU or other extenuating neonatal health circumstances. Neonates have been able to use BiPAP and CPAP machines for the past several decades, and more technological advances have made BiPAP and CPAP machines a staple in hundreds of NICUs nationwide. The exact prevalence of neonates on either BiPAP or CPAP machines is not known, but BiPAP or CPAP use is not a routine intervention for all NICU admissions or all deliveries.

Neonates must be assessed before administration of BiPAP and CPAP use to determine the need, extent, duration, frequency, dosage, and strength of either machine use. Neonatal conditions can also determine if a neonate receives BiPAP or CPAP use (9,10,11).

Unlike adult populations, neonates are unable to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to neonates receiving BiPAP or CPAP care. The use of blankets, pain medications, skin-to-skin care, breastmilk or formula, dim lighting, and other interventions can be used when neonates are receiving BiPAP or CPAP care. It is also important to educate parents about the use of BiPAP and CPAP machines if they have an infant receiving this care in the NICU. Taking the time to educate and inform parents about these interventions is essential.

Assessing neonatal pain by examining for grimacing, excessive crying, skin change, and other factors every two hours is essential when giving BiPAP or CPAP to neonate patients. For instance, the NICU might have a pre-term infant at 30 weeks on a CPAP machine as a result of RDS and premature lungs and might need to be on a certain CPAP setting for at least two weeks. Another NICU patient might be a full-term infant at 40 weeks on a CPAP machine as a result of RDS during labor and might need to be on a certain CPAP setting for at least a few days. Because of the various differences in lung development, infant development, critical care, and acute monitoring needing for neonates, neonate use with BiPAP and CPAP machines is a special population that requires a good eye to detail and patient care (9,10,11).

BiPAP or CPAP Use and Considerations in Pediatric Populations

BiPAP and CPAP use are commonly seen in pediatric acute care settings, long-term care settings, and even homes across America. Children receiving BiPAP or CPAP care often are on either machine as a result of physical trauma, asthmatic flare-ups, disabilities, or other neonatal-developmental complications. Children on BiPAP or CPAP machines can start as young as a few months old and well into their teenage years.

Machines can vary and change as children age and develop into teenage years if they are on BiPAP or CPAP use for an extended period. Sometimes, some pediatric patients are started on BiPAP or CPAP in acute care settings, such as the medical-surgical unit, and then weaned off either machine at home for a few months. Other times, some pediatric patients start on BiPAP or CPAP machines and use these machines at home in addition to their daily medication regime. Because pediatric patients can use these machines at home, education on BiPAP and CPAP machines to parents, caregivers, and even patients themselves (depending on their age) are essential.

Pediatric patients have been able to use BiPAP and CPAP machines for the past several decades, and more technological advances have made BiPAP and CPAP machines a staple in hundreds of pediatric acute care settings nationwide. The exact prevalence of pediatric patients on either BiPAP or CPAP machines is not known, but BiPAP or CPAP use is not a routine intervention for all pediatric acute admissions. Pediatric patients must be assessed before administration of BiPAP and CPAP use to determine the need, extent, duration, frequency, dosage, and strength of either machine use (12,13,14,15,16).

Unlike adult populations, depending on the age of the pediatric patient, they might not be able to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to pediatric patients receiving BiPAP or CPAP care. The use of blankets, pain medications, quality time with loved ones, adequate nutrition, dim lighting, and other interventions can be used when pediatric patients are receiving BiPAP or CPAP care. It is also important to educate parents about the use of BiPAP and CPAP machines if they have a child receiving this care in the healthcare setting as well. Taking the time to educate and inform parents about these interventions is essential.

Assessing pediatric pain by examining for grimacing, excessive crying, skin change, and other factors every two hours is essential when giving BiPAP or CPAP to pediatric patients. For instance, the pediatric post-surgical unit might have a 14-year-old patient on a CPAP machine as a result of a recent MVA. Another example is a 5-year-old admitted to the local pediatric emergency room for an asthmatic flare-up that has persisted for several days. The communication skills, machine settings, parental involvement, patient involvement, and vital sign monitoring for these patients will vary significantly because of the difference in the health parameters for a 5-year-old compared to a 14-year-old. Because of the differences in pediatric populations, pediatric use with BiPAP and CPAP machines is a special population that requires a good eye for detail and comfort with pediatric patient care (12,13,14,15,16).

BiPAP or CPAP Use and Considerations in Populations with Physical Disabilities

BiPAP and CPAP use are commonly seen in several acute care settings, long-term care settings, and even homes across America. That said, patients of all sorts of abilities and health histories use BiPAP or CPAP machines. In particular, people with physical disabilities often are on either machine as a result of physical trauma, respiratory flare-ups, new on-set adult or pediatric physical disabilities, or other musculoskeletal complications.

Children and adults with physical disabilities on BiPAP or CPAP machines can stay on NIV for a few months or the rest of their lives. Depending on the extent of the physical disability, a patient might start BiPAP or CPAP in an acute setting and then transition to home use. For instance, a pediatric patient with cerebral palsy might start a CPAP machine use at home at the age of 8 as their lung function varies compared to an adult with a new onset of respiratory problems as a result of being diagnosed with amyotrophic lateral sclerosis (ALS) at age 54.

When considering the use of BiPAP and CPAP in patients with physical disabilities, it is important to be aware of the extent of their disability and the role of caregiver involvement. For some patients, their caregiver support is limited to parents, whereas other patients might have home health aides, extended family members, spouses, and adult children as well. The exact prevalence of patients with physical disabilities on either BiPAP or CPAP machines is not known, but BiPAP or CPAP use is not a routine intervention for all patients with a physical disability. Like all other patients, patients must be assessed before administration of BiPAP and CPAP use to determine the need, extent, duration, frequency, dosage, and strength of either machine use (12,13,14,15,16,17,18).

BiPAP or CPAP Use and Considerations in Patients with Sleep Disorders

BiPAP and CPAP use are commonly used for several patients with sleep disorders, such as obstructive sleep apnea (OSA), respiratory distress at night with COPD, and obesity hypoventilation syndrome (OHS). CPAP machines are often the gold standard for people with OSA and OHS; however, in some situations, BiPAP machines can be used as well for patients with these conditions.

CPAP machines are commonly used for patients with sleep disorders at night since patients with these conditions often have trouble maintaining adequate oxygenation during their sleep. Because of the prevalence of CPAP machines for sleep disorder patients, they are very common in homes across America, making patient and caregiver education a must. It is also important to note that children can have sleep disorders and can require the use of CPAP machines as well.

There are various CPAP machines and settings to be aware of, including follow-up from health care providers, maintaining supplies, and ensuring that the patient is regularly receiving adequate oxygenation. For most patients with sleep disorders, the use of a CPAP machine is lifelong. Patients with sleep disorders have been able to use CPAP machines for the past several decades. More technological advances have made CPAP machines more cost-effective, safer, and accessible for millions of people with sleep disorders.

Even though some patients might be on CPAP machines for years, it is important to remember that these patients must be still assessed regularly for their CPAP use to determine the need, extent, duration, frequency, dosage, and strength of either machine use (1,18,19,20,21,22,23,24).

The Role of Telemonitoring in Inpatient and Outpatient BiPAP or CPAP Use

With the rise of at home patient care, telehealth, and remote patient monitoring, several patients use CPAP or BiPAP machines in health care settings and then transition to home use. In fact, some patients never use either machine in a clinical setting and start using the machine on their own at home. While telemonitoring has expanded significantly in the past decade as a result of the rise of telehealth nursing, technological advances, and more widespread insurance and Internet coverage, making sure patients are aware of their machine settings, breathing, sleep patterns, and more is essential to nursing care.

While patients with a CPAP or BiPAP machine at home should routinely seek advice and guidance from their medical care provider, many times, patients and caregivers can self-monitor their machines for emergent complications. Patients should be aware that if they suspect any complications with their machines, such as machine malfunctions, increased trouble breathing, increased pain or discomfort, or chest pain, they should seek care at the closest emergency hospital. Even though there are many possible complications from CPAP or BiPAP machines, many patients report high levels of satisfaction with remote monitoring, such as more independence in their daily activities and less time in transit to medical appointments (25,26,27,28,29,30).

Patients can self-manage their machine by changing tubing as recommended by their health care provider, cleaning the machine with alcohol wipes or other disinfectant, monitoring the tubes and straps for any damage, and ensuring their remote monitoring systems are updated. Patients should speak to their healthcare provider regarding any extra straps, tubes, or supplies needed, ensuring they have a good clean area set up to care for their machine, a support system, and access to a local emergency room in case of any complications. Also, patients should be instructed to keep the CPAP or BiPAP machine area dry and with consistent access to electricity. Educating patients on care for their machines and medication regime is essential to reduce health complications (25,26,27,28,29,30).

Nursing Considerations

Nurses remain the most trusted profession for a reason, and nurses are often pillars of patient care in several healthcare settings. Patients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in BiPAP and CPAP patient education and management, here are some suggestions to provide quality care for patients on either BiPAP or CPAP (1,3,4,11,12,13,15,25,26,27,28,29,30).

1. Take a detailed health history of the patient. Oftentimes, vital signs and history-taking can be complex, especially in acute settings. Many times, BiPAP or CPAP machines are started in acute settings and then transitioned to home use. Correct, safe, and accurate use of either machine is essential for adequate oxygenation and health promotion. As nurses, it is important to be involved in the vital signs and history-taking process to learn about noticing any abnormalities or medical concerns that warrant medical attention.
2. As nurses, we are aware that complications from BiPAP or CPAP use can lead to rapid fluctuations in vital signs, such as respiratory rate and oxygenation levels. If a patient is complaining of symptoms that could be related to their CPAP or BiPAP use, such as chest pain, trouble breathing, or headaches, inquire more about that complaint.
3. Clearly ask the patient if they have any allergies, especially to certain adhesives or fabrics. Straps for these machines can cause an allergic reaction upon use. If the patient is unresponsive, review their chart for any allergies and have an allergic reaction protocol in place. Monitor their skin integrity and breathing for any changes as well.
4. Educate the patient and caregivers on BiPAP and CPAP administration. Explain to the patient about the importance of keeping their tubes, straps, and machines clean and free of infection. Educate the patient on signs of skin irritation on their face. Educate the patient to inform the nurse of any redness, pain, or swelling on the face. Take time to monitor the client for any complications of BiPAP or CPAP administration, such as changes in respiratory rates or oxygenation.
5. Regardless of how long a client has been on BiPAP or CPAP, if the client complains of any new symptom, ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a patient’s complaint is not being taken seriously by other healthcare professionals, advocate for that patient to the best of your abilities.
6. Review medication history at every encounter. Often, in busy clinical settings, reviewing health records can be overwhelming, especially for patients with a complex medical history. Most patients using BiPAP or CPAP have a complex medical history. Millions of people take medications for various reasons, and people’s medication histories can look similar over time. Ask each patient about how they are feeling on the medication, how they are feeling with their central line if their symptoms are improving, and if there are any changes to medication history.
7. Be willing to answer questions about BiPAP and CPAP use and care. Many people do not know about the side effects, risk factors to be aware of, and lifestyle changes that can influence outpatient care. Be willing to be honest with yourself about your comfort level discussing topics and providing education on BiPAP and CPAP administration in inpatient and outpatient settings.
8. Communicate the care plan to other staff involved for continuity of care. For several patients, especially for patients with BiPAP or CPAP use, care often involves a team of nurses, specialists, pharmacies, caregivers, and more. Ensure that patients’ records are up to date for ease in record sharing and continuity of care.
9. Stay up to date on continuing education related to BiPAP and CPAP use, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other healthcare professionals and educate your patients with the latest information.
10. At your regular assessments, assess the BiPAP or CPAP machine settings, straps, and tubes at least once per shift. Document your findings, and make sure you change tubing or straps per your facility’s protocols.
11. Educate the patient on not getting the machine wet, damaged, or broken. Inform the patient to report any complications with the machine to the nurse immediately. If this patient is an outpatient, inform the patient to seek emergency medical care if they have complications. If the patient has caregivers, educate the caregivers on the importance of outpatient BiPAP and CPAP safety, care, and administration.
12. Make sure the intensity and speed of the BiPAP or CPAP machine are working and set to the correct rate per the provider’s order. If there are any issues with the infusion pump, make sure to adjust the rate, dosage, and other factors before administration. Also, if there are complications with the machine, you can request another machine per your facility’s protocol. If the client is at home and notices any issues with the infusion pump, educate them on contacting their health care provider or steps on ordering a replacement.

How can nurses identify if someone needs more intervention for their BiPAP or CPAP administration and care?

Unfortunately, it is not possible to look at someone with the naked eye and determine if they are struggling with their BiPAP or CPAP machine. While some people might have notable complications, such as trouble breathing or sharp headaches, the most common presentation for BiPAP or CPAP complications varies widely. In addition, nurses can answer questions and concerns regarding the use of these machines for both patients and their caregivers.

Nurses can also provide information on BiPAP and CPAP use, therapy options, medication options, and more. Nurses can provide quality care by completing health history, listening to patient’s concerns, addressing caregiver’s concerns, and performing CPAP and BiPAP care (1,3,4,11,12,13,15,30).

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors)
• Tell the health care provider of any existing lifestyle concerns, such as alcohol use, other drug use, sleep habits, diet, surgical history, and allergies (need to identify lifestyle factors that can influence BiPAP and CPAP use and therapy interventions)
• Tell the health care provider if you have any changes to your body, such as pain with breathing, trouble with movement, changes in sleep habits, or increased fatigue (potential systemic BiPAP or CPAP complication symptoms)
• Tell the nurse of health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life, especially if pain or discomfort is near the central line site
• Keep track of your health, medication use, machine function, and health concerns via an app, diary, or journal (self-monitoring for any changes)
• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries
• Administer the BiPAP or CPAP machine on schedule as discussed with the provider (need to maintain BiPAP or CPAP machine consistency for adequate oxygenation)
• Tell the health care provider if you notice any changes while on BiPAP or CPAP (potential worsening or improving health situation)
• Track your oxygenation with an at-home oximeter, keep track of your readings, and report any changes to your healthcare provider (self-monitoring for any changes)

Research Findings

There is extensive publicly available literature on NIV options, such as BiPAP and CPAP use, education, and more via the National Institutes of Health (NIH) and other evidence-based journals.

What are some ways for people who are using BiPAP or CPAP devices to become a part of research?

If a patient is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and healthcare organizations

Conclusion

The use of CPAP and BiPAP machines often requires extensive medical care and follow-up. While NIV technology can be lifesaving for many patients, because of the risks, a serious overview of risks and benefits must be considered before being on a BiPAP or CPAP machine. Education and awareness of different NIV options and different clinical presentations of respiratory complications can influence the lives of many people healthily.

Case Study #1

Wendy is a 36-year-old woman working as a nail technician and an established patient at the local health clinic. She has a medical history of two C-sections, obesity, and asthma. Wendy is at the clinic for her annual, where she was newly diagnosed with OSA. She has been having trouble sleeping for the past few months, and her children state that she is snoring louder than ever before.

She obtains a referral to go to the local sleep clinic because she wants to learn more about her treatment options. At the sleep clinic, she states that she wants something cost-effective, non-surgical, and immediate since she is the primary financial support for her two children under 5. She is interested in learning if any pills can help with snoring and asthma. Wendy’s vital signs are 130/80, 90 bpm, 99F, 20rr, 99% oxygenation.

Case Study #1 Continued

After talking with Wendy, Wendy wants to learn more about CPAP use at home. Wendy takes some of the material from the nurse and reads about it. The nurse also demonstrates using a sample CPAP machine in the office. Wendy is concerned about the straps on her face, as sometimes, she has to get up at night to help her children. She also wants to know if the straps and tubes are something that she can buy online. She also wants to know if she has to use this during the day as well.

Case Study #1 Continued

Wendy expresses concern about using the CPAP machine at home since she thinks it would scare the children, and she’s never used anything like this at home. She orders the CPAP machine through her insurance, and it arrives within a week. The sleep clinic has set the settings to the machine pre-ordered. Wendy set up the machine, and she is enrolled in remote patient monitoring through the sleep clinic.

Case Study #1 Continued

Wendy reports taking the CPAP daily since her last visit with the sleep clinic a few weeks ago, and the sleep clinic scheduled a telemedicine consult with her six weeks later. The nurse sees that Wendy is busy as a single mom with her children in the video background, and the nurse asks Wendy how she is doing.

Wendy tells the nurse that she has been taking her CPAP at home at night with no changes to the machine setting. She thinks she is snoring less because her kids do not say they hear her snoring as much. Wendy also reports 3/10 pain today with the straps on her face and wants to know how to manage that.

Wendy also wants to know if she can take her CPAP machine when she goes to visit her mom overseas in a few months. She also wants to know what can be done if her children sleep in bed with her because a few days ago, one of her children had a fever and pulled the tubes by accident.

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