Question: CPAP for CHF and COPD is to maintain a constant pressure in the airways (splinting with COPD) and to help push the fluid out of the alveoli and into the circulation with CHF. Would paramedics who do not have CPAP available be wrong, if the patient is conscious and tolerates, assist each inhalation with a BVM to increase tidal volume and create more positive pressure during inhalation, although not maintained with exhalation, in an attempt to force the fluid out with CHF. Debate is that we assist the ventilation at one breath every 5 seconds or 12/minute unless hyperventilating due to head trauma and respiratory problems with coning of the pupil(s). Thanks for the assistance.

Great question. The use of the BVM is a decision that paramedics make every day based upon judgment as to the patient's level of consciousness and respiratory effectiveness/distress as well as where indicated by the BLS Patient Care Standards.

If a patient is in respiratory distress and has an oxygen saturation of < 90% or accessory muscle use such that CPAP would be considered (and CPAP is not available) then it would be reasonable to consider using a BVM to assist with ventilations.

Strictly speaking however, providing ventilations through the BVM does not provide a continuous level of airway pressure (although with the use of a PEEP valve on a BVM we may be able to approach some level of continuous airway pressure) therefore the physiology (and potentially the benefit) may not be the same. Bottom line: the use of the BVM is a skill that paramedics must be familiar with and used as per their own judgment and the BLS Patient Care Standards but not as a substitute for CPAP.

Airway/Breathing,Continuous Positive Airway Pressure (CPAP)

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