II. Indications

  1. Obstructive Sleep Apnea
    1. See CPAP for Obstructive Sleep Apnea
  2. Loud continuous snoring
  3. Noninvasive positive airway pressure in respiratory distress (BIPAP offers similar respiratory support)
    1. See Acute Respiratory Failure
    2. Bridge to intubation in severe respiratory illness
    3. Adult Respiratory Distress Syndrome (ARDS)
    4. Refractory Hypoxemia
    5. Respiratory failure in children and chronic airway disease

III. Contraindications

  1. See Non-Invasive Positive Pressure Ventilation
  2. See Advanced Airway Indications
  3. Central Sleep Apnea
  4. Respiratory failure (requires intubation)
  5. Altered Level of Consciousness with increased aspiration risk

IV. Mechanism

  1. Non-Invasive Positive Pressure Ventilation
    1. Used during spontaneous breathing (as with BIPAP)
  2. Pressure above atmospheric maintained at airway opening
    1. Maintained throughout respiratory cycle
    2. Acts as airway splint to prevent collapse of alveoli and Bronchioles
      1. Also decreases airway resistance by Splinting open inflamed or bronchospastic airways
      2. Overcomes anatomic airway resistance (e.g. Obstructive Sleep Apnea)
    3. Increases surface area for gas exchange
      1. Increases oxygen diffusion and improves Hypoxemia
    4. Decreases work of breathing
      1. Decreases pressure required on inspiration
  3. Same end-expiratory pressure as with PEEP
  4. Lower Inspiratory pressure excursion than with PEEP
    1. CPAP requires less pressure to open
    2. PEEP requires a greater work of breathing

V. Approach: Noninvasive positive airway pressure in respiratory distress

  1. See Acute Respiratory Failure
  2. Indications
    1. Hypoxemic Acute Respiratory Failure (inadequate tissue Oxygen Delivery)
      1. Interstitial Lung Disease
      2. Congestive Heart Failure
      3. Pneumonia
    2. Not indicated for hypercarbic Acute Respiratory Failure
      1. CPAP only delivers Oxygen and increased end-expiratory pressure
      2. Only BiPap (increases Tidal Volume) or Mechanical Ventilation can correct Ventilatory failure
  3. Delivery Mechanisms
    1. High Flow Nasal Cannula
    2. Face Mask
  4. Technique CPAP Face Mask
    1. Target pressure range: 5-10 mmHg (continuous airway pressure)
      1. Contrast with the bi-level airway pressure of BIPAP (e.g. 15 mmHg inspiratory and 5 mmHg expiratory)
      2. CPAP pressure can be increased up to a maximum of 20 mmHg
        1. Pressure >20 mmHg exceeds lower esophageal sphincter pressure
    2. Start
      1. Set initial cpap pressure to 2-3 cm H2O
      2. Patient self-applies face mask
      3. Slowly increase the pressure

VI. Adverse Effects: Relates to decreased mask tolerance

  1. Nasal dryness or congestion
  2. Mask air leakage
  3. Claustrophobia
  4. Skin irritation or abrasions
  5. Conjunctivitis

VII. Efficacy: Noninvasive positive airway pressure in respiratory distress

  1. CPAP and BIPAP have similar outcomes in respiratory distress
  2. CPAP may be better tolerated in some cases (no need to synchronize their breaths with different inspiratory and expiratory pressure phases)
  3. Li (2013) Am J Emerg Med 31(9): 1322-7 [PubMed]

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Ontology: Continuous Positive Airway Pressure (C0199451)

Definition (MSH) A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. (On-Line Medical Dictionary [Internet]. Newcastle upon Tyne(UK): The University Dept. of Medical Oncology: The CancerWEB Project; c1997-2003 [cited 2003 Apr 17]. Available from: http://cancerweb.ncl.ac.uk/omd/)
Concepts Therapeutic or Preventive Procedure (T061)
MSH D045422
ICD10 92038-00
SnomedCT 229309006, 229307008, 47545007
CPT 94660
LNC MTHU016449, LA6176-7
English Continuous positive airway pressure [CPAP], CPAP, CPAP - Cont pos air pres ther, Cont pos airways pres therapy, Cont positive airways pressure, Continuous CPAP, Continuous positive airways pressure, Continuous Positive Airway Pressure, continuous positive airway pressure ventilation, continuous positive airway pressure ventilation (treatment), CPAP (continuous positive airway pressure ventilation), cpap ventilation, continuous positive airway pressure (CPAP), cpap treatment, Continuous positive airway pressure, Continuous positive airway pressure ventilation, Continuous CPAP (regime/therapy), Continuous positive airways pressure (observable entity), Pressure.continuous positive airway, CPAP Ventilation, Ventilation, CPAP, Continuous positive airway pressure ventilation treatment, CPAP treatment, CPAP - Continuous positive airways pressure, Continuous positive airways pressure therapy, CPAP - Continuous positive airways pressure therapy, Continuous positive airway pressure ventilation treatment (regime/therapy), Continuous CPAP (procedure), Continuous positive airway pressure ventilation treatment (procedure), CPAP (continuous positive airway pressure), continuous positive airway pressure
Italian Pressione continua positiva delle vie aeree, Pressione positiva continua delle vie aeree, Ventilazione CPAP, Pressione positiva continua delle vie respiratorie
French CPAP, PPC (Pression Positive Continue), Ventilation PPC, Ventilation CPAP, VPPC, Ventilation en pression positive continue, Pression positive continue des voies aériennes supérieures, Pression des voies aériennes positive continue
German CPAP, kontinuierlich positiver Druck der Atemwege, Continuous Positive Airway Pressure, CPAP-Beatmung, Kontinuierlicher positiver Atemwegsdruck
Japanese 持続的気道陽圧, CPAP, ジゾクテキキドウヨウアツ, CPAP, 経鼻的持続気道陽圧呼吸, 持続陽圧気道圧, 経鼻持続気道陽圧, 持続的気道陽圧法, 持続気道陽圧, 気道圧解除換気法
Swedish Kontinuerligt positivt luftvägstryck
Czech trvalý přetlak v dýchacích cestách, CPAP, Kontinuální pozitivní tlak v dýchacích cestách
Finnish CPAP
Russian DYKHATEL'NYE PUTI, POLOZHITEL'NOE DAVLENIE POSTOIANNOE, ДЫХАТЕЛЬНЫЕ ПУТИ, ПОЛОЖИТЕЛЬНОЕ ДАВЛЕНИЕ ПОСТОЯННОЕ
Polish Pomoc oddechowa typu CPAP, Ciągłe dodatnie ciśnienie w drogach oddechowych, Terapia oddechowa ciągłym ciśnieniem dodatnim, Stałe dodatnie ciśnienie w drogach oddechowych, Ciśnienie stałe dodatnie w drogach oddechowych, CPAP
Hungarian Folyamatos pozitív légút nyomás, CPAP
Norwegian Kontinuerlig positivt luftveistrykk, CPAP
Spanish CPAP, presión positiva continua de la vía aérea (régimen/tratamiento), presión positiva continua de la vía aérea, tratamiento de CPAP, tratamiento de ventilación con presión positiva continua en la vía aérea (procedimiento), tratamiento de ventilación con presión positiva continua en la vía aérea (régimen/tratamiento), tratamiento de ventilación con presión positiva continua en la vía aérea, ventilación mecánica controlada, Presión de vía respiratoria positiva continua, Presión de las Vías Aéreas Positiva Contínua
Portuguese Pressão Positiva Contínua nas Vias Respiratórias, Ventilação com Liberação de Pressão das Vias Respiratórias, VLPVA, Pressão positiva contínua nas vias respiratórias, Pressão Positiva Contínua nas Vias Aéreas
Dutch continue positieve luchtwegdruk, APRV, Continuous Positive Airway Pressure, CPAP