BIPAP (bilevel small portable ventilators ) : DR ANOOP KUMAR

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What is the best way to use BIPAP IN ARDS , since keeping the port  on mask open  to allow CO2 washout will lead to PEEP Loss ?

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00:00:00 intro
00:01:45 Exhalation, vented/non vented masks/ exp leak port
00:09:14 rise time, t min, t max
00:12:43 modes on bipap
00:19:05 resmed stellar 150 bipap machine
00:23:23 copd case
00:38:45 choosing the mask size
00:33:09 initial settings in copd
00:42:05 dr tapesh bansal pearls

Non-Invasive Ventilation ( Bipap ) Explained

Dr  Anoop Kumar and Dr Tapesh Bansal conducted a webinar on non-invasive ventilation, focusing on the topic of bipap, or small portable ventilators. They explained the different modes of non-invasive ventilation, how it supports patient breathing, and how it can be optimized. They emphasized the importance of a continuous pressure to push out exhaled gases and clarified common misconceptions about ventilation. They also introduced the concept of a 'vented mask', which allows for gas to escape during exhalation and carbon dioxide to be expelled.

Leak Ports, Non-Vented Masks, and Respiratory Cycle

Dr  Anoop discussed the use and importance of leak ports and non-vented masks in the context of medical ventilation. He emphasized that the leak port should never be obstructed and explained its function in allowing air to exit when using a dual-link circuit. He further highlighted the modifications that can be made to reduce the transmission of viral particles, such as adding a viral filter before the leak port. Finally, Dr  Anoop explained the respiratory cycle, including the concepts of inspiratory and expiratory phases, positive and expiratory pressure, and the importance of minimizing the time it takes to reach maximum inspiratory flow.

Understanding Ventilation Modes and Concepts

Dr  Anoop explained the concepts of inspiratory time (Ta) and expiratory time (Te) in the context of mechanical ventilation. He clarified that in constant positive airway pressure (CPAP) mode, Ta is constant and the ventilator switches from inspiration to expiration at Ta, with Ta minimum and Ta maximum setting the limits for patient inspiration. Dr Anoop also discussed the other ventilation modes like spontaneous mode, CPAP, and others, emphasizing the importance of understanding these modes for proper ventilation. He encouraged questions and clarifications from the listeners.

Mechanical Ventilator Modes Explained




Dr  Anoop explained the various modes of a mechanical ventilator, focusing on patient-controlled and machine-controlled modes. He detailed how the machine provides a continuous flow during both inspiration and expiration in the Continuous Positive Airway Pressure (CPAP) mode, often used in obstetrics and to prevent sleep apnea. He further explained the Spontaneous mode, where the patient initiates and terminates breaths, and the machine can intervene using minimum and maximum time functions. Dr Dr Anoop also discussed the Pressure Assist Control (PAC) mode, where all breaths are terminated at the minimum inspiratory time, and the Time mode, used for controlled ventilation of sedated or paralyzed patients.

Stellar 150 Machine User Guide

Dr  Anoop explained the functionalities and settings of the Stellar 150 machine used for patient monitoring and ventilation. He detailed how to navigate the system, including how to view various parameters such as battery charge, tidal volume, respiratory rate, and pressure flow. He also discussed the settings for different pathology types and the options for adjusting the machine's ramp-up time and other advanced settings. Finally, he presented a clinical scenario of a 65-year-old patient with severe breathlessness and respiratory failure, illustrating how the machine's readings correlate with the patient's condition.

COPD Patient Management Strategy Discussed


Dr Anoop also explained the process of selecting the appropriate NIV device and mask size for patients, emphasizing the importance of using a caliper to determine the correct size, and using high-quality masks to avoid nasal injuries.

Optimizing Mechanical Ventilator Settings for Patients

Dr Anoop provided detailed instructions on how to optimize the settings of a mechanical ventilator for patients with acute respiratory distress. He emphasized the importance of various parameters such as backup rate, trigger sensitivity, inspiratory time, and positive end-expiratory pressure (PEEP) to ensure patient comfort, reduce work of breathing, and improve lung function. He also discussed potential issues like triggering and flow deficits, and how to address them. Additionally, he explained how these settings can be adjusted for different patient scenarios, such as in cardiogenic pulmonary or respiratory failure.


Dr Tapesh  -  settings for patients with mild ARDS and emphasized the importance of understanding the differences between the settings on a bipap machine and a dedicated ventilator.