The use of Bi-level positive pressure ventilation in the treatment of acute respiratory failure within the emergency department

Acute respiratory failure (ARF) is one of the eight leading causes of death for over 65-year-olds in Australia. Bi-level positive pressure (BiPAP) ventilation is the preferred form of non-invasive ventilation in the treatment of acute respiratory failure in the emergency department (ED) because, when used appropriately, it reduces the need for intubation. The patient on whom BiPAP is applied is able to protect their own airway, remaining cooperative with a normal mental state. In this paper, I explain acute respiratory failure, the appropriateness of BiPAP in the treatment of ARF, patient selection and exclusion from BiPAP treatment, current practice and recommendations for future practice. While BiPAP is commonly used in Australian EDs as part of the treatment of acute respiratory failure, evidence supporting its use is limited and more high level research is recommended.