Which type of ventilation is most often used for acute-on-chronic respiratory failure?

• A. Continuous positive airway pressure (CPAP)
• B. Bilevel positive airway pressure (BiPAP)
• C. Noninvasive positive-pressure ventilation (NIV)
• D. Invasive mechanical ventilation

Answer: (B)

Bilevel positive airway pressure (BiPAP) is often the preferred mode for managing acute-on-chronic respiratory failure due to its ability to provide different levels of pressure during inhalation and exhalation. This feature allows for improved gas exchange and can reduce the work of breathing for patients with conditions such as chronic obstructive pulmonary disease (COPD) exacerbations.

BiPAP optimizes ventilation by delivering higher pressure during inhalation, which helps to recruit collapsed alveoli and enhance oxygenation. At the same time, it employs a lower pressure during exhalation, making it easier for patients to breathe out and reducing the respiratory effort. This dual pressure setting is particularly beneficial for patients who may still have some respiratory drive but require assistance to alleviate their respiratory distress.

The other modes mentioned have their indications, but they do not offer the same level of tailored support as BiPAP in the context of acute-on-chronic respiratory failure. Continuous positive airway pressure (CPAP), for instance, provides a constant pressure that may not adequately facilitate the varying needs of patients during both inhalation and exhalation. Noninvasive positive-pressure ventilation (NIV) is a broader category that includes various forms of ventilation, but BiPAP specifically is often the