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COVID-19 infection is surprisingly unpredictable because the virus is still new to humans. In most countries, it has been observed that severe infections cause respiratory failure, requiring respiratory and ventilatory support.

Bilevel positive airway pressure (BiPAP) is a type of ventilator that helps people breathe. It should be recommended in the following conditions:

• Hypoxemia (low blood oxygen level) that persists despite high-flow oxygen therapy
• Heart-related pulmonary edema (excess fluid in the lungs)
• Severe pneumonia or acute respiratory distress syndrome with immune suppression
• Chronic obstructive pulmonary disease as a preexisting condition

BiPAP helps improve breathing in people who have severe difficulty in breathing irrespective of the lung injury being COVID-19 related.

What is BiPAP?

Bilevel positive airway pressure (BiPAP) is a small device used for ventilation in people with chronic obstructive pulmonary disease (COPD). It maintains a consistent breathing pattern at night or during symptoms flare-ups.

BiPAP and continuous positive airway pressure (CPAP) are two types of noninvasive ventilation therapies.

BiPAP is usually recommended in the following conditions:

• COPD
• Pneumonia
• Asthma flare-ups
• Poor breathing after an operation
• A neurological disease that disturbs breathing
• Obstructive sleep apnea
• Obesity hypoventilation syndrome

However, BiPAP should be avoided in the following situations:

• Poor breathing
• Reduced consciousness
• Difficulty swallowing

BiPAP has a unique setting to deliver air pressure compared with other ventilators.

• In BiPAP, you receive positive air pressure while breathing in and out.
• However, the pressure that you receive while breathing in is higher air pressure.
• On the contrary, in CPAP, you will receive the same air pressure while breathing in and out.

How effective is BiPAP for COVID-19?

Bilevel positive air pressure (BiPAP) improves breathing in people with breathing difficulties. 

Because there aren’t many studies that report the efficacy of BiPAP to treat COVID-19, it is hard to estimate the effectiveness. However, one study has focused on the shortcomings of using BiPAP.

• There are high chances of inhaling more air pressure due to inappropriate settings made in BiPAP, leading to lung injury.
• Additionally, before starting BiPAP, the physician must assess the person for a collapsed lung (pneumothorax) and check for abnormal breath sounds.
• There might be a risk of virus transmission; hence, this method may not be feasible in a pandemic situation.

What may be the dangers of using BiPAP in COVID-19?

When on bilevel positive air pressure (BiPAP), if the person doesn’t respond to the therapy or eventually if their condition deteriorates, they may have further complications.

Shifting to a tracheostomy at this point would be of no use because the person may no longer respond to this therapy. Eventually, the person may die due to a declining health condition.

Using BiPAP hasn’t garnered any positive response from research. There is a lack of evidence from current clinical trials on using BiPAP to treat COVID-19 outside hospital settings.