What are the standard settings for Bi-Level Positive Airway Pressure (BiPAP) therapy?

From the Guidelines

Standard BiPAP settings typically start with an inspiratory positive airway pressure (IPAP) of 8-12 cmH2O and an expiratory positive airway pressure (EPAP) of 4-5 cmH2O, with a pressure support of at least 4-5 cmH2O, as recommended by the American Academy of Sleep Medicine 1.

Key Considerations for BiPAP Settings

• The initial settings for volume-targeted pressure support include 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 1.
• For patients with obstructive sleep apnea, settings may begin at IPAP 8-10 cmH2O and EPAP 4-5 cmH2O, while patients with COPD or other respiratory conditions might require higher pressures, with IPAP 12-20 cmH2O and EPAP 4-8 cmH2O 1.
• The respiratory rate is usually set at 12-16 breaths per minute, and oxygen can be added to maintain oxygen saturation above 88-92% 1.

Adjusting BiPAP Settings

• IPAP and/or EPAP should be increased as described in AASM Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea until obstructive respiratory events are eliminated 1.
• The pressure support (PS) should be increased every 5 minutes if the tidal volume is low (< 6 to 8 mL/kg) 1.
• Regular monitoring of blood gases, oxygen saturation, and patient comfort is essential for optimal BiPAP management 1.

Important Notes

• These settings are starting points, and settings should be individualized based on patient comfort, underlying condition, and response to therapy 1.
• Volume-targeted BPAP has the potential advantage of automatically varying the pressure support to deliver a targeted tidal volume 1.

From the Research

Standard Settings for Bi-Level Positive Airway Pressure (BiPAP) Therapy

The standard settings for BiPAP therapy can vary depending on the patient's condition and the specific device being used. However, based on the available evidence, the following settings have been reported:

• Initial settings:
  • EPAP: 4 cm H2O 2
  • IPAP: 16 cm H2O 2
• Adjusted settings:
  • EPAP: 4-8 cm H2O 3
  • IPAP: 14-18 cm H2O 3
• Dynamic flow-targeted settings:
  • EPAP: 6.5 +/- 1.7 cm H2O 4
  • IPAP: dynamically ranging between 0 and 15 cm H2O above the EPAP 4
• Computational Fluid Dynamics (CFD) analysis settings:
  • IPAP/EPAP: 12/8,16/6, and 18/8 cmH2O 5

Factors Affecting BiPAP Settings

The BiPAP settings can be affected by various factors, including:

• Patient's condition:
  • Obstructive Sleep Apnea (OSA) 2, 5
  • Chronic Obstructive Pulmonary Disease (COPD) 3, 6
  • Central Sleep Apnea (CSA) 4, 5
• Device settings:
  • Inspiratory and expiratory positive airway pressures (IPAP and EPAP) 2, 3, 4, 5
  • Pressure support and positive end-expiratory pressure (PEEP) 6
• Patient's response:
  • Respiratory comfort and stability 3
  • Oxygen saturation and respiratory rate 3
  • Work of breathing and respiratory muscle effort 6