From the Guidelines
Inspiratory pressure support (IPS) is beneficial in various respiratory pathologies, including chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), pneumonia, and cardiogenic pulmonary edema, by reducing the work of breathing and improving alveolar ventilation 1.
Pathologies that Benefit from IPS
- Chronic obstructive pulmonary disease (COPD)
- Acute respiratory distress syndrome (ARDS)
- Pneumonia
- Cardiogenic pulmonary edema
- Weaning from mechanical ventilation
In these conditions, IPS helps overcome airway resistance and improves gas exchange by providing positive pressure during inspiration.
Typical Settings for IPS
- Range from 5-20 cmH2O depending on the severity of the condition
- Lower pressures (5-8 cmH2O) used during weaning
- Higher pressures for acute respiratory failure
IPS is typically delivered through ventilators or non-invasive devices like BiPAP machines and should be titrated based on respiratory rate, tidal volume, and patient comfort 1.
Physiological Benefits of IPS
- Reduces the energy expenditure of respiratory muscles
- Decreases oxygen consumption
- Improves gas exchange
- Prevents respiratory muscle fatigue
These benefits are particularly important in patients with limited respiratory reserve or increased metabolic demands. However, it is crucial to carefully select patients for IPS and monitor them closely to avoid delaying necessary intubation, especially in cases of severe respiratory failure 1.
From the Research
Pathologies that Benefit from Inspiratory Pressure Support
Inspiratory pressure support is beneficial in various pathologies, including:
- Chronic obstructive pulmonary disease (COPD) 2, 3, 4, 5
- Adult respiratory distress syndrome (ARDS) 3, 5
- Postsurgical complications 3
- Pneumonia 5
- Sepsis 5
- Acute respiratory failure due to different pathologies 3
Effects of Inspiratory Pressure Support on Breathing Pattern and Respiratory Work
The application of inspiratory pressure support can lead to:
- Improved breathing pattern and gas exchange in COPD patients 2
- Reduced ineffective respiratory efforts in COPD patients 2
- Comparable pressure-time product of the diaphragm in patients with different pathologies 3
- Increased ability of patients to control tidal volume in response to alterations in respiratory demand 4
Outcomes of Patients with Severe COPD Requiring Mechanical Ventilation
Patients with severe COPD requiring mechanical ventilation have:
- Good early outcomes, but significant long-term morbidity 5
- Lower ICU mortality and hospital mortality when admitted with a COPD exacerbation compared to other etiologies of acute respiratory failure 5
- Improved overall survival when discharged home 5
Noninvasive Ventilation after Extubation
Noninvasive ventilation immediately after extubation can: