From the Guidelines
The normal starting pressure for BiPAP should be 8 cm H2O for inspiratory positive airway pressure (IPAP) and 4 cm H2O for expiratory positive airway pressure (EPAP). This recommendation is based on the guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea, as stated in the study by the American Academy of Sleep Medicine 1.
Key Considerations
- The pressure settings should be individualized based on the patient's condition, body size, and the specific reason for BiPAP therapy.
- For patients with obstructive sleep apnea, higher EPAP may be needed to maintain airway patency, while those with COPD or neuromuscular disorders might require higher IPAP to support ventilation.
- The pressure settings are typically titrated upward as needed to achieve therapeutic goals such as reducing respiratory effort, improving gas exchange, and ensuring patient comfort.
- Monitoring oxygen saturation, respiratory rate, and patient comfort is essential when initiating BiPAP therapy to determine if pressure adjustments are necessary.
Adjusting Pressure Settings
- IPAP and/or EPAP should be increased until obstructive respiratory events such as apneas, hypopneas, respiratory effort-related arousals, and snoring 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.
- The PS may be increased if the arterial PCO2 remains 10 mm Hg or more above the PCO2 goal at the current settings for 10 minutes or more 1.
From the Research
Normal Starting Pressure for BiPAP
- The normal starting pressure for BiPAP can vary depending on the patient's condition and the specific device being used.
- According to a study published in 1998 2, the initial settings for inspiratory and expiratory positive airway pressures (IPAP, EPAP) were set at 8 and 4 cm H2O respectively.
- Another study from 1999 3 used BiPAP settings with expiratory positive airway pressure (EPAP) = 8 cm H2O and inspiratory positive airway pressure (IPAP) = 12 cm H2O.
- A 2004 study 4 compared continuous positive airways pressure (CPAP) and bilevel non-invasive ventilation, using CPAP (10 cm H(2)O) and bilevel ventilation (IPAP 15 cm H(2)O, EPAP 5 cm H(2)O).
- It's worth noting that the optimal starting pressure may depend on the individual patient's needs and response to treatment, and should be determined by a healthcare professional 2, 3, 4.
Key Findings
- The initial IPAP and EPAP settings can be adjusted based on the patient's respiratory status and comfort level 2.
- Increasing EPAP has theoretical advantages during overnight nasal ventilation, particularly for patients with neuromuscular/skeletal disorders 5.
- BiPAP ventilation can increase PaO2 and decrease PaCO2 more than CPAP in patients with heart failure 3.
Patient Response
- Patients with cystic fibrosis showed a marked improvement in their respiratory status with nocturnal use of BiPAP 2.
- Patients with neuromuscular/skeletal disorders had a lower maximum transcutaneous carbon dioxide tension (PtcCO2) overnight when expiratory positive airway pressure was added to BiPAP 5.
- Patients with chronic obstructive pulmonary disease (COPD) did not show significant improvement with the addition of expiratory positive airway pressure to BiPAP 5.