What are the standard BiPAP (Bilevel Positive Airway Pressure) settings for FiO2 (Fraction of Inspired Oxygen)?

From the Guidelines

Standard BiPAP settings for FiO2 should start at 40-50%, titrated to maintain SpO2 between 88-92% for patients with COPD or at risk for hypercapnic respiratory failure, and 92-96% for other patients, as recommended by recent guidelines 1.

Key Considerations for BiPAP Settings

• The goal of BiPAP therapy is to provide adequate oxygenation and ventilation while minimizing the risk of hyperoxia and respiratory acidosis.
• Initial FiO2 settings should be based on the patient's oxygen saturation levels, with adjustments made as needed to maintain the target SpO2 range.
• For patients with hypoxemic respiratory failure, higher FiO2 levels may be required initially, while those with hypercapnic respiratory failure benefit more from appropriate pressure support 1.

Adjusting BiPAP Settings

• BiPAP settings should be adjusted based on patient comfort, work of breathing, and arterial blood gas results.
• Regular assessment of the patient's response to therapy is essential, as BiPAP settings often need adjustment during the course of treatment to optimize ventilation and oxygenation.
• The pressure support (difference between IPAP and EPAP) should be at least 5 cmH2O to provide adequate ventilatory support, with initial IPAP commonly set at 10-12 cmH2O and EPAP starting at 4-5 cmH2O.

Important Guidelines for BiPAP Use

• Monitoring of transcutaneous arterial oxygen saturation (SpO2) is recommended to guide FiO2 adjustments 1.
• Non-invasive positive pressure ventilation, including BiPAP, should be considered in patients with respiratory distress and started as soon as possible to decrease respiratory distress and reduce the rate of mechanical endotracheal intubation 1.
• Caution should be exercised when using BiPAP in hypotensive patients, as it can reduce blood pressure, and regular monitoring of blood pressure is recommended 1.

From the Research

BiPAP Settings for FiO2

• The standard BiPAP settings for FiO2 are not explicitly stated in the provided studies, but the studies suggest that the FiO2 can vary depending on several factors, including the type of leak port, oxygen injection site, and ventilator settings 2, 3.
• A study found that the FiO2 increased with oxygen flow, but it was difficult to obtain an FiO2 >0.30 unless very high oxygen flows were used 2.
• Another study found that the delivered oxygen concentration was affected by the choice of leak port, oxygen injection site, and ventilator settings, and that the highest oxygen concentration was achieved with oxygen added to the mask, with the leak port in the circuit, and with the lowest settings of inspiratory and expiratory positive airway pressure 3.
• A study on noninvasive bilevel positive airway pressure for preoxygenation of the critically ill morbidly obese patient found that oxygen flow of 10 L/min achieved full saturation of 99% 4.
• A decision support system for setting positive end expiratory pressure (PEEP) and fractional inhaled oxygen concentration (FIO2) recommended appropriate combinations of PEEP and FIO2 to achieve and maintain pulse oximeter oxygen saturation (SpO2) ≥ 88 and ≤ 95% 5.

Factors Affecting FiO2

• The type of leak port used can affect the FiO2, with the leak port in the mask resulting in a lower oxygen concentration 3.
• The site of oxygen injection can also affect the FiO2, with oxygen added to the circuit resulting in a higher oxygen concentration than oxygen added to the mask 3.
• The ventilator settings, including inspiratory and expiratory positive airway pressure, can also affect the FiO2, with higher settings resulting in a lower oxygen concentration 3.
• The oxygen flow rate can also affect the FiO2, with higher flow rates resulting in a higher oxygen concentration 2, 4, 3.