Let’s talk about CPAP—Continuous Positive Airway Pressure. You’ve probably heard about CPAP, PEEP, and BiPAP, but let’s break them down.

CPAP stands for Continuous Positive Airway Pressure. It’s exactly what it sounds like: continuous positive pressure is pushed into the lungs. This serves two main purposes:

  1. Keeping the alveoli open: Alveoli are tiny air sacs in the lungs where gas exchange occurs. Oxygen goes in, and carbon dioxide goes out. Keeping these open ensures efficient gas exchange.
  2. Clearing out unwanted substances: CPAP helps clear any fluid or debris from the lungs.

Now, let’s talk about PEEP—Positive End Expiratory Pressure. We measure PEEP when the patient exhales. It keeps some positive pressure in the lungs even after exhalation, ensuring the alveoli stay open.

What’s the difference between CPAP and BiPAP?

The primary distinction is how pressure is managed:

What is CPAP?

Continuous pressure in and hard to exhale against, which can make patients anxious.

What is BiPAP?

Provides two levels of pressure—high when inhaling and lower when exhaling—making it easier for patients to breathe out. This is why BiPAP is often more comfortable for patients, especially in long-term settings like hospitals.

When to Use CPAP in the Ambulance

Here are four main indications for using CPAP:

  1. Asthma
  2. COPD
  3. Congestive Heart Failure (CHF)
  4. Pneumonia

Remember, the goal of CPAP is to keep the alveoli open and clear out anything that shouldn’t be in the lungs, improving gas exchange.

Contraindications for CPAP

There are situations where CPAP should not be used:

  • Inability to obey commands: Patients need to be able to follow basic instructions, as CPAP can be intimidating.
  • Hypotension: CPAP can decrease blood return to the heart, lowering blood pressure further.
  • Active vomiting: This can cause aspiration if the patient vomits while the mask is on. Treat vomiting first before using CPAP.
  • Pneumothorax: Do not use CPAP if the patient has a pneumothorax. High pressure can worsen the condition.

Final Tips for Using CPAP

  1. Sit the patient upright when administering CPAP.
  2. Initial pressure settings: Start with 5–10 cm H2O.
  3. Monitor vitals and lung sounds constantly to avoid complications like pneumothorax.
  4. Use cardiac monitoring and get a 12-lead EKG when needed.

Remember to reassess your patient regularly, and keep an eye on their respiratory status. CPAP can be a life-saving intervention when used correctly. Keep practicing, and you’ll become more comfortable with these tools over time.