From the Guidelines
The BiPAP rate should be individualized and titrated based on the patient's response, with a typical range of 10-20 breaths per minute and a common starting point of 12-14 breaths per minute for most adult patients. When setting a BiPAP, it's essential to consider the patient's underlying condition, respiratory mechanics, and comfort. For patients with COPD or obesity hypoventilation syndrome, lower rates (10-12) may be preferred to avoid air trapping, while patients with neuromuscular weakness might benefit from higher rates (14-18) 1. The backup rate should be set slightly below the patient's spontaneous respiratory rate to allow for natural breathing while ensuring ventilatory support if needed.
Key Considerations for BiPAP Settings
- The patient's underlying condition, such as COPD or neuromuscular weakness, should guide the initial BiPAP rate setting
- Respiratory mechanics, including tidal volume and minute ventilation, should be monitored and used to adjust the BiPAP rate as needed
- Patient comfort is crucial, and the BiPAP rate should be adjusted to minimize discomfort and promote adherence to therapy
- The BiPAP rate should be titrated based on the patient's response, including oxygen saturation, work of breathing, and arterial blood gas results if available 1
Adjusting BiPAP Settings
- The pressure support (PS) should be increased every 5 minutes if the tidal volume is low (< 6 to 8 mL/kg) 1
- The PS should be increased if the arterial PCO2 remains 10 mm Hg or more above the PCO2 goal at the current settings for 10 minutes or more
- The BiPAP rate may be increased if respiratory muscle rest has not been achieved by NPPV treatment at the current settings for 10 minutes or more 1
From the Research
BiPAP Settings
The rate for BiPAP can vary depending on the patient's condition and the specific settings used. Some studies have reported the following BiPAP settings:
- IPAP (Inspiratory Positive Airway Pressure) of 12-25 cmH2O and EPAP (Expiratory Positive Airway Pressure) of 5 cmH2O 2
- IPAP/EPAP of 10/5 cm water (low BiPAP) and 20/5 cm water (high BiPAP) 3
- IPAP of 15 cm H2O and EPAP of 5 cm H2O 4
- IPAP of 14 cm H2O and EPAP of 4 cm H2O (PS10) 5
BiPAP Efficacy
The efficacy of BiPAP in various conditions has been studied, including:
- Acute cardiogenic pulmonary oedema: BiPAP has been shown to be effective in reducing the rate of endotracheal intubation and mortality 4, 6
- Chronic obstructive pulmonary disease (COPD): BiPAP has been used as an adjunct to exercise, but its effect on exercise capacity in COPD patients is unclear 5
- Non-COPD acute hypercapnic respiratory failure: BiPAP has been shown to be effective in reducing the rate of endotracheal intubation and mortality, similar to CPAP 6
BiPAP Comparison to Other Treatments
BiPAP has been compared to other treatments, including:
- CPAP: BiPAP has been shown to be similar to CPAP in reducing the rates of endotracheal intubation and mortality in patients with acute cardiogenic pulmonary oedema 4, 6
- Invasive mechanical ventilation: BiPAP has been shown to be effective in reducing the rate of endotracheal intubation and mortality, compared to invasive mechanical ventilation 6
- Oxygen therapy: BiPAP has been shown to be effective in reducing the rate of endotracheal intubation and mortality, compared to oxygen therapy 4, 6