Who Adjusts BiPAP Settings After Overnight Pulse Oximetry Shows Oxygen Flow Insufficiency
The patient's prescribing physician (typically a pulmonologist or sleep medicine specialist) is responsible for ordering BiPAP setting changes, but the actual adjustment is performed by trained respiratory therapists, sleep technologists, or appropriately trained nurses under physician supervision, ideally during attended polysomnography in a sleep center. 1
Physician Oversight and Responsibility
- The physician who prescribed the BiPAP maintains continuing responsibility for supervision of the patient and must review the overnight pulse oximetry results to determine if settings changes are warranted 1
- When oxygen flow insufficiency is identified, the physician should order formal attended polysomnography for proper titration rather than making blind adjustments based solely on home pulse oximetry data 1
Personnel Who Perform the Actual Adjustments
Multiple trained healthcare professionals can successfully adjust BiPAP settings:
- Sleep technologists are the most common personnel performing BiPAP titrations during attended polysomnography 1
- Respiratory therapists frequently manage ventilator adjustments in both inpatient and outpatient settings 1
- Trained nurses can successfully set up and maintain NPPV, particularly in ICU/HDU settings 1
- Physiotherapists and lung function technicians have also been reported to successfully adjust BiPAP settings 1
Proper Titration Protocol
The appropriate response to oxygen insufficiency findings requires:
- Attended polysomnography in a sleep center for proper titration, not home adjustments 1
- If supplemental oxygen is needed, it should be added only after pressure support (IPAP-EPAP differential) and respiratory rate have been optimized 1
- Supplemental oxygen should start at 1 L/minute and be increased in 1 L/minute increments every 5 minutes until SpO2 >90% is achieved 1
- Pressure support may need to be increased if SpO2 remains below 90% for 5 minutes or more and tidal volume is low 1
Close Follow-Up Requirements
- Close follow-up after BiPAP initiation by appropriately trained healthcare providers is essential to establish effective utilization patterns, remediate side effects, and assess measures of ventilation and oxygenation to determine if further adjustments are needed 1
- Serial evaluation and adjustment of BiPAP is necessary as the patient's requirements change over time 1
Common Pitfalls to Avoid
- Do not make blind setting adjustments based solely on home pulse oximetry data without proper attended titration 1
- Home pulse oximetry alone is insufficient for determining optimal BiPAP settings—it can detect problems but cannot guide precise pressure adjustments 1
- The airway company that performed the overnight testing typically cannot and should not adjust settings without physician orders and proper clinical oversight 1