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Discussion

Maximum time on BiPap

Could someone tell me why there is a time limitation on Bipap?

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I don't like bipap much. It's only meant to get a patient through a brief period of acute treatment, trying to avoid intubation, as in acute CHF. The masks can erode the skin of the face, the patients can't really be fed, they can't really speak and may require some sedation, it can be impossible to do pulmonary toilet if the patient desaturates off the mask...and what if the patient vomits into the mask, can't get it off, and you're in your other patient's room?

Could someone tell me why there is a time limitation on Bipap?

There is so much maximum time on bipap as the patiënt can endure. If he is still cooperative and has a sufficient enough own respiration, there is no limit.

Otherwise, is the patient is after hours of CHF still on bipap with no recovery, there might be an indication for intubation.

I've seen DNI patients stay on Bipap as long as a week, but IMO it seems like torture. Just watching a tachypnic patient trying to blow off CO2 on one of those things is exhausting. Longer-term use of bipap also results in some freaky ABGs.

  • Experts

A few years ago we had a toddler with BOOP whose parents refused to consider a trach. He had on full-facemask BiPAP for nearly two years (didn't do well with a nasal mask) the last time I heard about him. He was NJ fed, had horrible skin breakdown along his nasolabial folds, his nasal bridge became deformed and he had a significant developmental delay compared to his healthy twin. Still couldn't convince the parents to trach him. I'm not sure where he is now, or even IF he is.

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