2Īll three devices are used noninvasively, but BiPAP and NIV will provide more support to the patient by providing pressure supported inspiratory breaths (set as inspiratory positive airway pressure of IPAP) along with an elevated baseline pressure (set as an expiratory positive airway pressure of EPAP). For these patients, CPAP and BiPAP will not provide enough support or may not have appropriate alarms, so non-invasive ventilation (NIV) may be required. These patients include those with neuromuscular disease, chest wall deformity, central hypoventilation or obesity hypoventilation, severe obstructive sleep apnea, failure to improve with nasal CPAP, and COPD with severe hypercapnia or nocturnal desaturation. Beyond this, some patients will have higher complexity in their health issues due to respiratory disease or comorbid conditions, or have a high risk of quickly digressing into respiratory failure. This provides the expiratory positive pressure (CPAP) and adds a pressure supported breath to increase tidal volume. Patients with chronic respiratory issues may have support at home provided by Continuous Positive Airway Pressure (CPAP) at the minimum to support oxygenation, or may need more mechanical support during inspiration and will be changed to Bilevel Positive Pressure (BiPAP). 1 With the increasing move to handle complex care at home, the right terminology for exactly what is needed becomes very important. The medical home allows patients to be cared for at home where in the past this care was only provided in the hospital. By Bill Pruitt, MBA, RRT, CPFT, AE-C, FAARCĪs technology advances in the sophistication of medical equipment in the home, as home monitoring to provide reports back to the primary care provider, and as the move toward the “medical home” continues, in-home respiratory support in particular is growing. However, when patients are being discharged to home care, the exact terminology used by physicians is essential in order to prescribe the precise therapy. In hospital settings, the terms “NIV” and “BiPAP” are often used synonymously.
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