What are the recommended parameters to document when reporting pressure support ventilator settings?

Documentation of Pressure Support Ventilator Settings

When reporting pressure support ventilator settings, clinicians should document IPAP (inspiratory positive airway pressure), EPAP (expiratory positive airway pressure), pressure support level, respiratory rate (spontaneous and/or backup rate), inspiratory time (or %IPAP time), FiO2, mode (spontaneous, spontaneous-timed, or timed), and any volume-targeted parameters if applicable. 1

Essential Parameters to Document

Pressure Settings

• IPAP: The inspiratory positive airway pressure (in cm H₂O)
• EPAP: The expiratory positive airway pressure (in cm H₂O)
• Pressure Support (PS): The difference between IPAP and EPAP (in cm H₂O)

Timing Parameters

• Mode: Spontaneous, Spontaneous-Timed (ST), or Timed (T) mode
• Respiratory Rate:
  • Patient's spontaneous rate
  • Backup rate (if in ST mode)
  • Set rate (if in T mode)
• Inspiratory Time (IPAP time): Typically reported in seconds
• %IPAP Time: Percentage of respiratory cycle spent in inspiration (typically 30-40%)
• I:E Ratio: Ratio of inspiratory to expiratory time

Oxygenation Parameters

• FiO₂: Fraction of inspired oxygen
• SpO₂/SaO₂: Target oxygen saturation range

Volume Parameters (if applicable)

• Target Tidal Volume: If using volume-targeted pressure support (e.g., AVAPS)
• Measured Tidal Volume: Actual delivered volume

Additional Settings

• Rise Time: Time taken to reach the set IPAP (pressurization rate)
• Trigger Sensitivity: Flow or pressure trigger settings
• Cycle Criteria: Flow termination percentage

Disease-Specific Considerations

For Obstructive Lung Disease

• Lower %IPAP time (30-35%) and I:E ratio to allow sufficient expiratory time
• Document expiratory flow limitations

For Restrictive Lung Disease

• Higher %IPAP time (35-40%) and I:E ratio to allow longer inspiratory time
• Document chest wall compliance issues

Volume-Targeted Pressure Support Documentation

When using volume-targeted pressure support (VT-BPAP), additional parameters should be documented 1:

• IPAP minimum: Typically EPAP + 4 cm H₂O
• IPAP maximum: Usually 25-30 cm H₂O
• Target tidal volume: Typically 8 mL/kg ideal body weight

Common Pitfalls in Documentation

1. Incomplete documentation: Failing to document all essential parameters
2. Inconsistent terminology: Using different terms for the same parameters across documentation
3. Missing patient-ventilator synchrony issues: Not documenting observed asynchrony
4. Inadequate documentation of changes: Not recording the rationale for setting changes
5. Overlooking leak information: Failing to document significant mask leaks

Algorithm for Comprehensive Documentation

1. Document baseline settings (IPAP, EPAP, PS, mode, rate, inspiratory time)
2. Record patient response (respiratory rate, SpO₂, work of breathing)
3. Document any adjustments made and rationale
4. Note any synchrony issues or leaks
5. Record supplemental oxygen requirements
6. Document humidification settings

By following this structured approach to documentation, clinicians ensure comprehensive communication of ventilator settings, which is essential for continuity of care and optimal patient management.