From the Research
For a cold exacerbation, initial BiPAP settings typically include an inspiratory positive airway pressure (IPAP) of 10 cmH2O and expiratory positive airway pressure (EPAP) of 5 cmH2O, as evidenced by a study published in the Annals of Emergency Medicine 1.
Key Considerations
- The study found that BiPAP patients had a significantly greater increase in peak expiratory flow rate (PEFR) after each treatment, suggesting the effectiveness of BiPAP in managing bronchospasm.
- The initial settings can be adjusted based on patient response, with the goal of achieving adequate tidal volumes and reducing work of breathing.
- It is essential to monitor the patient closely, checking arterial blood gases and adjusting the BiPAP settings as needed to ensure optimal ventilation and oxygenation.
Adjusting BiPAP Settings
- Titrate IPAP upward by 2-3 cmH2O increments to achieve adequate tidal volumes (6-8 mL/kg) and reduce work of breathing, potentially up to 20-25 cmH2O if needed.
- Maintain the EPAP at 4-6 cmH2O to prevent alveolar collapse and counterbalance intrinsic PEEP.
- Set the respiratory rate at 12-16 breaths per minute as a backup.
Target Oxygen Saturation
- Target oxygen saturation between 88-92% for most patients to avoid carbon dioxide retention.
- Monitor the patient closely for the first 1-2 hours, checking arterial blood gases after 30-60 minutes to assess ventilation effectiveness.
Additional Considerations
- The use of BiPAP in conjunction with other therapies, such as bronchodilators and corticosteroids, may be beneficial in managing cold exacerbations, as suggested by studies published in Chest 2 and The New England Journal of Medicine 3.
- A single-inhaler combination therapy for maintenance and relief of asthma may also be an effective strategy in disease management, as endorsed by the Global Initiative for Asthma and supported by studies published in Drugs 4.