Minimum Inspiratory Pressure (IPAP) on BiPAP
The recommended minimum starting IPAP on BiPAP is 8 cm H₂O for both adult and pediatric patients. 1, 2
Standard Initial Settings
Start with IPAP of 8 cm H₂O and EPAP of 4 cm H₂O as the baseline for all patients, regardless of age. 1, 2
The 4 cm H₂O EPAP represents the lowest available setting on most BiPAP devices and serves as the foundation for pressure support. 1
This creates an initial minimum pressure support (PS) of 4 cm H₂O (the difference between IPAP and EPAP), which provides modest ventilatory assistance while allowing patient adaptation to positive pressure. 1
Rationale for Minimum Settings
The 8 cm H₂O minimum IPAP is based on consensus from the American Academy of Sleep Medicine PAP Titration Task Force, representing the lowest clinically meaningful inspiratory pressure that maintains adequate pressure support. 1
Starting at this level allows gradual patient acclimatization to positive airway pressure rather than initiating at higher pressures that may cause discomfort and poor adherence. 1
The 4 cm H₂O minimum pressure differential must be maintained at all times during titration to ensure adequate ventilatory support. 1, 2
Pressure Differential Requirements
Never allow the IPAP-EPAP differential to fall below 4 cm H₂O during any adjustment. 1, 2
The maximum recommended pressure differential is 10 cm H₂O for obstructive sleep apnea patients. 1, 2
For patients requiring noninvasive positive pressure ventilation for chronic alveolar hypoventilation, the maximum pressure support can reach 20 cm H₂O. 1
Clinical Context for Higher Starting Pressures
Patients with elevated BMI may warrant higher initial IPAP and EPAP settings than the standard 8/4 cm H₂O, though the exact pressures should be determined by body habitus. 1, 2
Retitration studies may also justify starting at higher pressures based on previous titration results. 1
Despite these exceptions, the absolute minimum IPAP remains 8 cm H₂O—you may start higher but never lower. 1
Common Pitfall to Avoid
- Do not confuse IPAP with pressure support (PS). IPAP is the absolute inspiratory pressure delivered, while PS is the difference between IPAP and EPAP. 1 For example, IPAP 8 cm H₂O with EPAP 4 cm H₂O provides PS of 4 cm H₂O.