From the Guidelines
BIPAP Settings for Carbon Dioxide Retention
For CO2 retention, BIPAP settings should be adjusted to ensure adequate ventilation and respiratory support. A recommended starting point is to set the IPAP (inspiratory positive airway pressure) between 15-20 cmH2O and the EPAP (expiratory positive airway pressure) between 5-10 cmH2O, with a backup respiratory rate of 10-12 breaths per minute 1. The inspiratory time should be set between 1.0-1.5 seconds and the rise time to 100-200 ms.
- Key Adjustments:
- Increase IPAP and/or EPAP to eliminate obstructive respiratory events such as apneas, hypopneas, respiratory effort-related arousals, and snoring 1.
- Increase pressure support (PS) if the tidal volume is low (< 6 to 8 mL/kg) or if the arterial PCO2 remains high 1.
- Consider adding supplemental oxygen and titrating the FiO2 to maintain an SpO2 of 88-92% 1.
- Monitoring: Close monitoring of the patient's respiratory status, including arterial blood gases, is essential to adjust the BIPAP settings as needed to prevent CO2 retention and ensure optimal respiratory support 1.
- Mode of Operation: BIPAP can be delivered in spontaneous (S), spontaneous-timed (ST), or timed (T) mode, with the choice depending on the patient's needs and response to therapy 1.
From the Research
BIPAP Settings for Carbon Dioxide Retention
The BIPAP settings for carbon dioxide retention are not explicitly stated in the provided studies. However, the following information can be gathered:
- A study published in 2021 2 used maximum IPAP started at 20 cmH2O and minimum IPAP set at 5 cmH2O higher than expiratory positive airway pressure (EPAP) in AVAPS mode, with IPAP levels titrated up to 30 cmH2O.
- A study published in 2003 3 used an initial pressure of 8/3 cm H2O, which was gradually raised to 12/7 cm H2O inspiratory positive airway pressure/expiratory positive airway pressure.
- A study published in 1995 4 used a positive inspiratory airway pressure of 10 cm H2O and a minimal level of positive end-expiratory pressure (PEEP).
- A study published in 2004 5 used BiPAP settings of 10/5,15/5,20/5,15/10,20/10, and 25/10 cm H2O at respiratory rates of 15 and 25 breaths/min.
Key Considerations
- The choice of leak port, oxygen injection site, and ventilator settings can affect oxygen delivery during BiPAP 5.
- CO2 rebreathing can occur with the standard BiPAP system, but can be prevented by using a nonrebreathing valve 4.
- The effectiveness of BiPAP in treating respiratory failure has been shown in several studies 2, 6, 3.
BIPAP Settings
Some possible BIPAP settings for carbon dioxide retention include:
- IPAP: 10-30 cmH2O
- EPAP: 5-10 cmH2O
- Respiratory rate: 15-25 breaths/min
- Oxygen flow: 5-10 L/min
Note: These settings are not explicitly recommended for carbon dioxide retention and may vary depending on the individual patient's needs and medical condition.