What is the maximum inspiratory pressure (MIP) on BiPap (Bilevel Positive Airway Pressure)?

Maximum Inspiratory Pressure (IPAP) on BiPAP

The maximum IPAP on BiPAP is 20 cm H₂O for patients under 12 years of age and 30 cm H₂O for patients 12 years and older. 1

Age-Based Maximum IPAP Guidelines

Pediatric Patients (< 12 years)

• Maximum IPAP should not exceed 20 cm H₂O 1, 2
• This lower threshold accounts for smaller airway anatomy and reduced tolerance to high pressures in children 1

Adolescent and Adult Patients (≥ 12 years)

• Maximum IPAP should not exceed 30 cm H₂O 1, 2
• Most BiPAP devices have a maximum capability of 25-30 cm H₂O 1

Starting and Minimum Settings

• Minimum starting IPAP: 8 cm H₂O for all ages 1, 2
• Minimum starting EPAP: 4 cm H₂O for all ages 1, 2
• Minimum pressure support (IPAP-EPAP differential): 4 cm H₂O 1, 2

Maximum Pressure Support Differential

For Obstructive Sleep Apnea

• Maximum IPAP-EPAP differential: 10 cm H₂O 1, 2
• This limit prevents excessive pressure swings that may cause discomfort or central apneas 1

For Chronic Alveolar Hypoventilation

• Maximum pressure support: 20 cm H₂O 1, 3
• Higher differentials are needed to achieve adequate tidal volumes (6-8 mL/kg ideal body weight) and CO₂ elimination in patients with restrictive lung disease or neuromuscular disorders 1

Titration Algorithm

• Increase IPAP by 1-2 cm H₂O increments at intervals no shorter than 5 minutes 1, 2
• Continue titration until respiratory events are eliminated OR maximum IPAP is reached 1, 2
• If patient awakens complaining of excessive pressure, reduce to a comfortable level that allows return to sleep 1, 2

Common Pitfalls to Avoid

• Do not exceed age-appropriate maximum IPAP even if respiratory events persist—consider alternative interventions such as positional therapy, weight loss, or surgical evaluation 1
• Avoid increments larger than 2 cm H₂O during titration to prevent overshooting optimal pressure and causing discomfort 1
• Do not persist with uncomfortable pressures as this leads to poor adherence and treatment failure 1, 2
• Ensure proper mask fitting before reaching high pressures, as leaks become more problematic at higher IPAP settings and reduce treatment effectiveness 2