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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So I had a question from Paul, and Paul says, “Not knowing if my wife will be able to get off the BIPAP machine, and what are the next steps in ICU?”
Now, it’s sort of a fairly generic question. But it’s still a very relevant question. Many patients in ICU are on BIPAP.
BIPAP basically means they’re on a ventilator with a mask, not with a breathing tube or a tracheostomy. It’s also referred to as non-invasive ventilation. And it’s often the first step before someone gets intubated or in the ideal world, it’s preventing intubation. And this is probably where Paul is coming in. The ICU team has probably told him that if she can’t come off the BIPAP, she probably needs intubation and go on a ventilator with a breathing tube or an endotracheal tube.
Now you want to avoid that at all costs in ICU, if you can. And how can you do that, if someone is on a BIPAP or a non-invasive ventilation?
So most importantly, you got to put them in the right settings. How much PEEP (positive end-expiratory pressure)? How much pressure support? How much FiO2 (fraction of inspired oxygen)? Monitor arterial blood gases. Monitor tidal volumes. Monitor minute volumes. Listen to someone’s chest with the stethoscope, do chest X-rays and potentially do a CT (computed tomography) of the chest to see what’s going on in the lungs.
What’s the reason for the BIPAP? There could be many reasons. It could be pneumonia, could be COVID, could be COPD (chronic obstructive pulmonary disease), and could be asthma. It could be sometimes even for people with scoliosis that they need BIPAP because the lungs can’t expand. There could be all sorts of reasons.
But in 2022, the main reason at the moment for people going on BIPAP is probably COVID, COVID pneumonia. It’s one of the most important questions and most frequently asked questions at the moment we’re getting, people with COVID in ICU, and this is probably what’s happening here.
So what else can you do to prevent intubation and get someone on the BIPAP to stay away from intubation? So mobilization, very important. What else is important? Mobilization, physical therapy, very important, also chest physiotherapy, and chest percussions. Then you also need to take people off the BIPAP, to give them a bit of a break, wash their face, give them something to drink or do mouth care, do eye care, and give them a wash. Very important, make sure they’re not getting pressure sores from the BIPAP mask. But more importantly, really making sure that the BIPAP is effective so you can gradually wean them off the BIPAP. That is the goal.
You don’t want to use the BIPAP forever. The goal should be getting someone off the BIPAP, getting them onto high flow nasal prongs or the Airvo machine, then getting them down to just nasal oxygen, and then wean oxygen off altogether. That should be the goal.
So again, in a nutshell, monitor arterial blood gases, monitor chest X-rays, monitor air entry, or listen to air entry, auscultate, chest physiotherapy, mobilization, and avoid intubation at all costs and get them out of ICU.
That’s it in a nutshell, there are articles and videos on our website, how to wean someone off the BIPAP in more depth, go to intensivecarehotline.com.
If you have a loved one in intensive care, call us on one of the numbers on the top of the website, or send us an email to [email protected] with your questions. You can also use the search function on our website and type in BIPAP and there are more articles about that.
Also, have a look at our membership for families in intensive care at intensivecaresupport.org.
If you want a medical record review while your loved one is in intensive care, again, check out the link below this video.
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My name is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.
Take care for now.