From the Guidelines
The initial BiPAP settings should be EPAP = 4 cm H2O, IPAP min = EPAP + 4 cm H2O, and IPAP max = 25 to 30 cm H2O, with an initial target tidal volume setting of approximately 8 mL/kg ideal body weight, and FiO2 should be started at 40-50% and titrated to maintain SpO2 between 88-92%. When setting up BiPAP, it's essential to consider the patient's specific needs and adjust the settings accordingly. The goals of BiPAP titration are to select an effective EPAP to eliminate obstructive events and to document that the device delivers adequate pressure support 1. Some key considerations for BiPAP settings include:
- IPAP min and max: The difference between IPAP min and max should be sufficient to provide adequate pressure support, with IPAP max not exceeding 30 cm H2O 1.
- EPAP: Should be adjusted to eliminate obstructive events, using recommendations for adjustment of CPAP in the AASM Guidelines for the titration of PAP in patients with OSA 1.
- FiO2: Should be titrated to maintain SpO2 between 88-92% for most patients, with the goal of ensuring adequate oxygenation while minimizing the risk of oxygen toxicity. It's crucial to monitor the patient's response to BiPAP therapy closely, especially in the initial hours, and adjust the settings as needed to optimize ventilation, oxygenation, and patient comfort 1.
From the Research
BiPAP Settings
- The initial settings for BiPAP were IPAP of 8 cm H2O and EPAP of 4 cm H2O, with IPAP increased by increments of 2 cm H2O and EPAP increased by 1 cm H2O increments until respiratory comfort was achieved 2.
- The final IPAP and EPAP settings ranged from 14 to 18 cm H2O and 4 to 8 cm H2O, respectively 2.
- In another study, IPAP was set at 10 cm H2O and EPAP was set at 5 cm H2O 3.
- Maximum IPAP was started at 20 cmH2O and minimum IPAP was set at 5 cmH2O higher than EPAP in AVAPS mode, with IPAP levels titrated up to 30 cmH2O 4.
- IPAP was started at 15 cmH2O in BPAP-S/T mode 4.
FiO2 Settings
- There is no direct information on FiO2 settings in the provided studies.
- However, one study mentions that patients' oxygen requirement dropped from a mean of 4.6 +/- 1.1 L/min to 2.3 +/- 1.5 L/min after using BiPAP 2.
- Another study mentions that arterial blood oxygen saturation was measured by pulse oximetry, but does not provide specific FiO2 settings 3.
Key Findings
- BiPAP therapy improves the respiratory status of decompensating end-stage CF patients 2.
- BiPAP is more effective in treating acute bronchospasm than small-volume nebulizer 3.
- AVAPS mode had similar efficiency with BPAP-S/T mode regarding the NIMV treatment success in critically ill patients with acute hypercarbic respiratory failure 4.
- Theoretical advantages of BiPAP ventilation are acknowledged, but larger randomized controlled research studies are recommended to ensure its safe and effective application in the treatment of ACPO 5.
- The reduction in work of breathing during bronchospasm is primarily induced by the IPAP component 6.