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Continuous positive airway pressure (CPAP) is a noninvasive ventilation modality that delivers a constant level of positive airway pressure throughout the respiratory cycle to maintain upper airway patency. This approach supports alveolar stability, enhances functional residual capacity, and improves ventilation-perfusion matching, ultimately optimizing oxygenation. CPAP is widely used in the management of obstructive sleep apnea, acute cardiogenic pulmonary edema, and selected cases of mild acute respiratory distress syndrome. Other clinical applications include perioperative respiratory support, post-extubation respiratory failure prevention, and weaning facilitation from mechanical ventilation. CPAP therapy requires appropriate equipment—typically a pressure generator, sealed interface, and delivery tubing—and carries potential risks such as barotrauma, gastric insufflation, pressure-related skin injury, and patient intolerance. Careful attention to contraindications, including hemodynamic instability and impaired consciousness, is essential for safe administration. This activity for healthcare professionals enhances the learner’s competence when administering CPAP therapy by emphasizing selection criteria, mechanisms of action, proper setup, and monitoring for complications. Participants gain a deeper understanding of clinical indications, contraindications, and strategies to improve patient adherence and minimize adverse outcomes. The course reinforces the importance of interprofessional collaboration among respiratory therapists, nurses, and clinicians to ensure timely implementation, effective patient education, and ongoing assessment. Coordinated care enhances clinical decision-making, facilitates early intervention, and improves respiratory function, patient safety, and overall outcomes. Objectives: Identify appropriate clinical indications and contraindications for initiating continuous positive airway pressure therapy in various patient populations. Differentiate between continuous positive airway pressure and other forms of noninvasive ventilation based on pathophysiologic needs and clinical scenarios. Improve communication strategies to educate patients with chronic respiratory conditions about the importance of compliance with continuous positive airway pressure therapy and address common barriers to long-term use.

Differentiate between continuous positive airway pressure and other forms of noninvasive ventilation based on pathophysiologic needs and clinical scenarios. Improve communication strategies to educate patients with chronic respiratory conditions about the importance of compliance with continuous positive airway pressure therapy and address common barriers to long-term use. Collaborate with other healthcare professionals to achieve positive outcomes for patients receiving continuous positive airway pressure. Access free multiple choice questions on this topic.

Continuous positive airway pressure (CPAP) delivers a continuous flow of air to open the airways in individuals who are spontaneously breathing. Positive end-expiratory pressure (PEEP) refers to the pressure in the alveoli above atmospheric pressure at the end of expiration (see Image. Airway Pressure Release Ventilation Pressure Cycles with Superimposed Spontaneous Breathing).[1] CPAP maintains PEEP by delivering constant pressure during both inspiration and expiration, measured in cm H2O. Unlike bilevel positive airway pressure, which varies pressure during inhalation (inspiratory positive airway pressure) and exhalation (expiratory positive airway pressure), CPAP requires patients to initiate all breaths without additional pressure above the set level. By maintaining PEEP, CPAP reduces atelectasis, increases alveolar surface area, improves ventilation-perfusion (V/Q) matching, enhances oxygenation, and maintains upper airway patency. While CPAP aids oxygenation, it is often inadequate for full ventilation support, which requires additional inspiratory pressure, as provided by noninvasive ventilation.[2] This activity reviews the mechanism of action, clinical indications, contraindications, preparation considerations, and potential complications of CPAP therapy in pediatric and adult populations.

The first few nights on CPAP may be challenging as patients adjust to the therapy. Many initially find the mask uncomfortable, claustrophobic, or embarrassing. Adverse events from CPAP treatment can include congestion, a runny nose, dry mouth, or nosebleeds, with humidification often alleviating these symptoms. Masks may cause skin irritation or redness. Using the correct size mask and adequate padding can help prevent pressure sores. The mask and tubing should be cleaned regularly, inspected, and replaced every 3 to 6 months. Abdominal distension or bloating may occur, rarely leading to nausea, vomiting, and aspiration. These issues may be minimized by reducing pressure or, in hospitalized individuals, performing gastric decompression through a tube. Compliance Despite the many benefits of CPAP therapy, compliance remains a significant challenge in both inpatient and outpatient settings. Patient compliance should be closely monitored, especially during the initiation of the treatment, to ensure long-term success.[17] Patients must report any adverse events that may limit compliance, which should be promptly addressed. Ongoing follow-up with an annual office visit is essential to check the equipment, adjust settings as needed, and ensure proper mask and interface fit. Continued patient education on the importance of regular use and support group involvement can help maximize CPAP therapy's benefits. In rare instances, those hospitalized may greatly benefit from CPAP but may not tolerate the mask or comply due to delirium, agitation, or age-related factors in children or older adults. In these cases, mild sedation with low-dose fentanyl or dexmedetomidine can help improve compliance until CPAP therapy is no longer needed. However, close monitoring is critical, as sedatives or anxiolytics can decrease consciousness and respiratory drive. If adequate minute ventilation and oxygenation are not achieved, escalation to bilevel positive airway pressure or intubation with mechanical ventilation should be considered, per the patient’s code status and care goals.

CPAP is commonly prescribed by primary care providers, nurse practitioners, internists, and neurologists for patients with obstructive sleep apnea. However, good compliance hinges on thorough patient education. Many patients discontinue use shortly after initiation due to discomfort. Although CPAP is an effective temporary treatment for OSA, it does not reduce the risk of cardiac complications. Patients should also be encouraged to lose weight, adopt a healthy diet, quit smoking, and exercise regularly to improve overall health outcomes.[19]