Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
HCPCS code
Respiratory Assist Device, Bi-Level Pressure Capability, With Back-Up Rate Feature (E0471)
Name of the Procedure:
Common Name(s): BiPAP with Backup Rate
Medical Term: Bi-level Positive Airway Pressure with Back-Up Rate
Summary
A bi-level positive airway pressure (BiPAP) device with a backup rate is a non-invasive therapy used to assist breathing. The device delivers pressurized air through a mask to help keep the airways open and ensure proper ventilation, especially during sleep. It provides different pressure levels during inhalation and exhalation and includes a backup rate feature that triggers breaths if the patient’s breathing rate falls below a preset level.
Purpose
This device is primarily used to manage:
- Sleep Apnea (both central and obstructive)
- Chronic Obstructive Pulmonary Disease (COPD)
- Respiratory failure
- Hypoventilation syndromes
The goal is to improve breathing, enhance oxygenation, and ensure consistent airflow, reducing symptoms like fatigue and shortness of breath.
Indications
- Severe obstructive sleep apnea unresponsive to CPAP therapy
- Central sleep apnea
- Chronic respiratory failure
- Patients needing ventilatory support outside of or supplementary to a hospital setting
- Conditions like ALS or obesity hypoventilation syndrome that impair breathing
Preparation
- Ensure the device is set up and calibrated by a healthcare professional.
- Get fitted for a suitable nasal or facial mask.
- Patients may need to undergo a polysomnography or sleep study to determine proper settings.
- Follow any specific instructions regarding medication or physical activity.
Procedure Description
- Setup: The patient’s mask is properly fitted.
- Starting the Device: The BiPAP machine is switched on and adjusted to prescribed settings.
- Breathing: The machine begins delivering pressurized air through the mask. The device alternates between higher pressure during inhalation and lower pressure during exhalation.
- Back-Up Rate: If the patient’s breathing rate drops below a preset threshold, the machine automatically increases its rate to maintain adequate ventilation.
Tools/Equipment: BiPAP device, nasal or facial mask, tubing, humidifier (optional).
Anesthesia/Sedation: Not typically required.
Duration
The device is generally used nightly or during specific episodes requiring assistance, duration varies based on individual needs.
Setting
- Home setting
- Sleep labs for initial setup and periodic assessments
Personnel
- Healthcare Providers: Respiratory therapists, sleep specialists, and nurses.
- Technicians: Those trained in setting up and calibrating the BiPAP device.
Risks and Complications
Common risks:
- Nasal dryness or congestion
- Skin irritation from the mask
- Mild discomfort or air leakage
Rare complications:
- Pneumothorax (very rare)
- Aspiration (in patients with swallowing difficulties)
Management typically involves consulting with healthcare providers for adjustments or addressing discomfort.
Benefits
- Improved sleep quality
- Enhanced daytime alertness
- Reduced symptoms of respiratory distress
- Better overall oxygenation and ventilation
Patients often notice benefits within a few nights to weeks of regular use.
Recovery
- Immediate improvement in breathing during use.
- Regular follow-ups are essential to adjust settings and mask fit.
- Maintain regular cleaning of the device and mask.
Alternatives
- Continuous Positive Airway Pressure (CPAP) without backup rate (for simpler cases).
- Use of Oxygen therapy.
Surgical interventions (e.g., for severe obstructive sleep apnea).
Pros and Cons:
- CPAP is simpler but less effective for central apnea or severe cases.
- Oxygen therapy doesn’t provide pressure support but may be necessary for hypoxemia.
- Surgery could provide a more permanent solution but carries higher risks.
Patient Experience
- Initial discomfort as the patient acclimatizes to the mask and pressure settings.
- Minimal to moderate noise from the device.
- Ongoing adjustments are often necessary to ensure comfort and effectiveness.
- Pain management may include proper mask fitting and device adjustments to reduce pressure soreness.
Proper education and support help patients adapt smoothly to using the BiPAP device.