From the Guidelines
IPAP (Inspiratory Positive Airway Pressure) is a crucial setting in non-invasive ventilation therapy that delivers pressure during inhalation to assist patients with breathing, typically started at 8 cm H2O and adjusted based on patient response and comfort. When considering the management of patients with obstructive sleep apnea (OSA), IPAP is a key component of bilevel positive airway pressure (BPAP) therapy, which also includes expiratory positive airway pressure (EPAP) 1. The American Academy of Sleep Medicine recommends starting IPAP at a minimum of 8 cm H2O for both pediatric and adult patients on BPAP 1. Some key points to consider when using IPAP include:
- Starting at a lower pressure and gradually increasing by small increments to ensure patient comfort and tolerance
- Monitoring patient response, including work of breathing, oxygen saturation, and overall comfort
- Adjusting IPAP based on the elimination of obstructive respiratory events such as apneas, hypopneas, and respiratory effort-related arousals (RERAs) 1
- Considering alternative therapies, such as CPAP, if patients are intolerant of high pressures or experience continued obstructive events 1. In clinical practice, IPAP is titrated to achieve optimal pressure support that reduces the work of breathing and improves alveolar ventilation, with the goal of enhancing patient outcomes and quality of life 1.
From the Research
Definition of IPAP
- IPAP stands for Inspiratory Positive Airway Pressure, which is a mode of positive airway pressure therapy used to treat sleep-disordered breathing and other respiratory conditions 2, 3, 4.
- IPAP is a component of bilevel positive airway pressure (BPAP) therapy, where two different pressure levels are applied during inhalation and exhalation 2, 3, 4.
How IPAP Works
- IPAP is set at a higher pressure level than expiratory positive airway pressure (EPAP) to assist with inhalation and improve lung expansion 2, 3.
- The IPAP pressure level can be adjusted to individual patient needs, and is typically increased in increments until respiratory comfort is achieved 2.
- IPAP can be used in conjunction with other modes of positive airway pressure therapy, such as CPAP and APAP, to provide optimal treatment for patients with obstructive sleep apnea and other respiratory conditions 5, 6.
Clinical Applications of IPAP
- IPAP has been shown to improve respiratory status and oxygenation in patients with end-stage cystic fibrosis awaiting lung transplantation 2.
- IPAP has also been used to treat patients with chronic obstructive pulmonary disease (COPD), although its effectiveness in reducing work of breathing in these patients is still debated 3.
- IPAP is considered a suitable mode of ventilation for patients who require progressive transition from controlled to augmented mechanical ventilation 4.