Advanced Respiratory Support at Sarkar Hospital, Agra
What is NIV (Non-Invasive Ventilation)?
Non-Invasive Ventilation (NIV) is a method of providing breathing support without inserting a tube into the airway. It delivers pressurized air, with or without oxygen, through a face or nasal mask to help patients breathe more effectively.
NIV reduces the work of breathing, improves oxygen levels, and helps remove carbon dioxide from the body. It is commonly used in acute and chronic respiratory failure under close medical supervision.
What is BiPAP?
BiPAP (Bi-Level Positive Airway Pressure) is the most commonly used form of NIV.
How BiPAP Works
BiPAP delivers two different pressure levels:
IPAP (Inspiratory Positive Airway Pressure):
Higher pressure during inhalation to assist breathing and improve ventilation.EPAP (Expiratory Positive Airway Pressure):
Lower pressure during exhalation to keep airways open and improve oxygenation.
Benefits of BiPAP
Reduces breathing effort
Improves oxygen and carbon dioxide exchange
Prevents alveolar collapse
Improves patient comfort compared to invasive ventilation
At Sarkar Hospital, Agra, BiPAP is widely used in the ICU, emergency department, and step-down units.
Indications for NIV / BiPAP
NIV and BiPAP are used when optimal medical treatment alone is insufficient.
Common Indications:
COPD exacerbation with respiratory acidosis (pH < 7.35)
Hypercapnic respiratory failure
Neuromuscular disorders
Chest wall deformities (scoliosis, kyphosis)
Weaning from invasive mechanical ventilation
Severe respiratory distress not requiring intubation
What is CPAP (Continuous Positive Airway Pressure)?
CPAP provides a constant fixed positive airway pressure during both inhalation and exhalation. Unlike BiPAP, CPAP does not provide ventilation, but keeps the airways open and improves oxygenation.
Indications for CPAP
CPAP is mainly used in hypoxic respiratory failure and airway collapse conditions.
Common Indications:
Cardiogenic pulmonary oedema
Severe hypoxia despite oxygen therapy
Pneumonia (as interim or ceiling of care)
Chest wall trauma (after ruling out pneumothorax)
Obstructive Sleep Apnoea (OSA)
Understanding the Physiology
Positive Airway Pressure
Positive pressure pushes air into the lungs, reducing respiratory effort and increasing lung expansion.
Recruitment
Positive pressure prevents alveolar collapse, increasing lung volume and improving gas exchange efficiency.
Contraindications for NIV / BiPAP / CPAP
These therapies may not be suitable in patients with:
Excessive secretions or vomiting (aspiration risk)
Reduced consciousness or inability to protect airway
Severe agitation or confusion
Facial trauma or burns
Recent facial, airway, or upper GI surgery
Undrained pneumothorax
In selected cases, NIV/BiPAP may be used if it is the ceiling of care.
Mask & Initial Settings
Full-face mask is usually preferred
BiPAP/NIV:
IPAP: 10 cm H₂O
EPAP: 4 cm H₂O
CPAP:
Starting pressure: 4 cm H₂O
Pressures are increased gradually based on patient response
Maximum pressure usually does not exceed 25 cm H₂O
A proper mask seal is essential for effective treatment.
Monitoring at Sarkar Hospital
Patients receiving NIV, BiPAP, or CPAP are closely monitored for:
Oxygen saturation (SpO₂)
Heart rate and blood pressure
Respiratory rate
Level of consciousness
Arterial blood gas (ABG) analysis
Possible Complications
Low blood pressure due to reduced venous return
Mask discomfort or pressure sores
Air leakage
Abdominal distension and aspiration risk
Patient intolerance
Our trained ICU team actively monitors and manages these risks.
Weaning from NIV / BiPAP / CPAP
BiPAP / NIV
Used continuously during the first 24 hours if beneficial
Gradual breaks introduced as the patient improves
Often continued overnight before complete discontinuation
CPAP
Pressure reduced gradually once stable
Trial off CPAP when pressure reaches 4 cm H₂O with stable oxygen levels