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Quick Tip for Families in Intensive Care: How Long Can a Patient be on BIPAP (Bilevel Positive Airway Pressure) Before Needing Intubation?

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, one question that we get quite frequently is, “How long can a patient be on BIPAP before needing intubation or a breathing tube? “ Now, many patients in intensive care need BIPAP or CPAP (continuous positive airway pressure). If someone needs BIPAP or CPAP, they are in some form of respiratory failure, whether it’s Type I or Type II respiratory failure and obviously, that’s getting them into intensive care. They need the BIPAP to breathe.

Often the indications for that are obviously respiratory failure like I mentioned. But also, this would be confirmed by a Chest X-ray or by a CT of the Chest. It would be confirmed by poor arterial blood gases when either PO2 (partial pressure of oxygen) is very low, or CO2 (carbon dioxide) is very high or sometimes a combination of both.

So, the goal of BIPAP is absolutely to keep someone off intubation, let’s be very clear here. The goal of a BIPAP machine is to prevent intubation and for a patient to need a breathing tube because that would come with many, many side effects such as induced coma. The use of sedatives and opiates, potentially the long-term use of such and you want to avoid that at all costs, really.

So, there’s really no time limit, how long can someone stay on BIPAP. However, if someone is in a critical condition, the “wear and tear” of someone needing BIPAP is quite high. It can be very exhausting, especially sometimes you can’t give patients on BIPAP the full nutrition they need because if you give them nutrition, either orally or through a PEG (Percutaneous Endoscopic Gastrostomy) tube or through a nasogastric tube, there’s a high risk of aspiration. If a patient on BIPAP aspirates, the risk of them needing intubation is again very high.

So therefore, there is limited fluid and nutrition intake recommended during BIPAP. One way to bypass that is to use TPN (Total Parental Nutrition) also known as intravenous nutrition. So, the backup is often used for pneumonia, for COPD (chronic obstructive pulmonary disease), Asthma, but also for chronic conditions, such as motor neuron disease, Cerebral Palsy, Myasthenia Gravis, as well. Again, the goal is always to prevent intubation and the use of a breathing tube.

So, like I said, this could go on for many days, sometimes many weeks and as long as you can keep a patient off the intubation and away from the breathing tube, hopefully the goal can be achieved.

Now, what is also very important is that patients get mobilized, that they get physiotherapy, that they can do deep breathing exercises during that time.

Another risk that patients face during this period is to get pressure sores in their face, especially on the nose because the BIPAP mask needs to be on the face quite tightly. Even though there are now nasal cushions as well, but the risk of a pressure area is real. It can be prevented with for example, with Comfeel or DuoDerm dressings to protect the skin.

So, what you need to assess during the BIPAP is obviously like I said, initially, chest x-ray, potentially a CT scan of the chest. You need to check regular blood gases, arterial blood gases, in particular. You also need to check the patient’s conscious state so that they can continue to tolerate BIPAP. For example, if they become more and more unconscious or drowsy, the risk of them aspirating is pretty high. Again, that gets the patient closer to needing intubation.

It’s also fairly risky if someone had a stroke, can’t swallow, can’t move, or has paraplegia, or hemiplegia. They are also at higher risk because they can’t take that buff mask off in case they’re vomiting. They always need to have the one-to-one nurse there.

Now, to illustrate this even further, some patients in ICU that I looked after having worked in intensive care for over 20 years in three different countries where I also worked as a nurse manager for over five years and having looked after thousands of critically ill patients in intensive care, for example, if someone has a pneumonia, when they have leukemia, or they just had chemotherapy, and they’re immunocompromised, it’s very, very important to keep them off intubation because their immune system is so weak. It would be very difficult to get them off the ventilator. So, there are a number of risks with BIPAP, but there are also many benefits if you can keep a patient off intubation.

Now, last but not least, some of you know that we are running a service in Intensive Care at Home. You can find out more information at intensivecareathome.com. With Intensive Care at Home, we are sending critical care nurses into people’s home predominantly not only for long-term ventilated adults and children with tracheostomies, but also, for patients on BIPAP and CPAP who need the critical care nurse there, 24 hours a day.

One of our goals is obviously to keep patients away from intubation or tracheostomy. We achieve that. It can all be done, but you have to have the right tools, the right skills, also the right mindset, very important when it comes to intensive care, when it comes to Intensive Care at Home, so that the patients and families get what they need in situations like that.

So, I hope that helps.

Also, with Intensive Care at Home, go to intensivecareathome.com. We are currently operating all around Australia in all major capital cities and rural and regional areas as well. If you need help with Intensive Care at Home in the U.S. or in the U.K., please contact us as well. We can help you privately.

Now, we also have a membership for families of critically ill patients in intensive care where we answer your questions in a membership area and via email and you can get access to our membership if you go to intensivecarehotline.com and you click on the membership link or you go to intensivecaresupport.org directly. We welcome you in our membership for families of critically ill patients in intensive care where we can help you really, really fast.

I also offer one-on-one consulting and advocacy over the phone, Skype Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly and I advise not only on what to do, how to position yourself, but I also talk to doctors and nurses directly with you. I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care. You will see once we’ve done that, it changes the dynamics in your favor because then the intensive care knows that you have someone on your team who understands intensive care inside out.

I also represent you in family meetings with intensive care teams. I have done that successfully, dozens, if not hundreds of times where families get great outcomes. I can confidently say that we have saved lives with Intensive Care Hotline through our consulting and advocacy, and we can still do the same for you. So, don’t despair. There is help at hand if you need it when you have a loved one in intensive care.

We also strategize with you whether you should even go into a family meeting with intensive care teams. Just because they ask you to go, doesn’t mean you should go. You have to have a strategy, but I can help you with all of that.

We also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell and comment below what you want to see next or what questions and insights you have.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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