The occasional acute application of continuous positive airway pressure.

Noninvasive positive pressure ventilation evolved over several decades because of the need to avoid the complications of intubation when respiratory support became necessary. The most useful modalities have been continuous positive airway pressure (CPAP) and biphasic positive airway pressure (BiPAP). The former supports respiration by presenting the airway with a constant pressure on inspiration and expiration. The latter supplies a higher pressure on inspiration than on expiration. BiPAP normally offers an advantage in respiratory failure, but does not in cases of acute cardiogenic pulmonary edema or exacerbations of chronic obstructive pulmonary disease (COPD). These 2 conditions constitute the majority of cases that benefit from noninvasive interventions in rural practice. Since CPAP is equally effective and much easier to set up, it is presently the intervention of choice in small hospitals. Most rural areas do not have respiratory therapists, and the equipment to deliver these interventions is notoriously difficult to set up, especially when done only occasionally. To achieve optimal results, it is also important to set up CPAP early when there is an indication. For this reason, a simpler way of administering CPAP is required. The Boussignac CPAP system (Vitaid Ltd.) is one solution, requiring only an oxygen source and regulator to supply a single-use valve and mask system. Objectives of the CPAP intervention include • reduced in-hospital and postdischarge mortality; • reduced need for intubation and the attendent complications; • improvement in clinical parameters and symptoms, allowing improved stabilization for transport, and possibly reduced need for transport; • improved patient comfort, with reduced need for sedation and analgesia; • simplified management of some types of respiratory failure in settings in which resources are limited.