From the Guidelines
To address high pressure complaints in a patient using a BiPAP ST/A device, the best initial step is to reduce the inspiratory positive airway pressure (IPAP) by 1-2 cmH2O increments while monitoring patient comfort and oxygen saturation, as recommended by the American Academy of Sleep Medicine 1. This approach is based on the principle of balancing patient comfort with effective treatment of the underlying respiratory condition.
Key Considerations
- Decreasing the pressure support (the difference between IPAP and EPAP) while maintaining adequate ventilation may also be considered if the patient continues to experience discomfort 1.
- Checking for mask leaks and adjusting the mask fit is crucial, as leaks can trigger the device to increase pressure to compensate 1.
- Evaluating rise time settings and extending them if necessary to create a more gradual pressure increase can also improve patient comfort, with patients with obstructive airway disease often preferring shorter rise times and those with restrictive disease preferring longer rise times 1.
- Adding a ramp feature that gradually increases to the prescribed pressure may help with adaptation for patients with significant discomfort 1.
Adjustments and Monitoring
These adjustments should be made while ensuring the patient maintains adequate ventilation and oxygenation, as excessive pressure reduction may compromise ventilatory support and lead to hypoventilation or increased work of breathing 1. The goal is to find a balance between patient comfort and effective treatment of the underlying respiratory condition, and adjustments should be guided by patient comfort and clinical judgment, with consideration of the potential benefits and risks of different settings 1.
From the Research
Adjusting BiPAP Settings for High Pressures
- When a patient is using a BiPAP machine and complaining of high pressures, the best setting adjustment can be determined by understanding the technology inside PAP devices and the algorithms used to control airflow and pressure 2.
- The settings for BiPAP can be adjusted to optimize therapy, including the use of ramp and expiratory pressure relief, and different modes of PAP therapy such as continuous positive airway pressure (CPAP), autotitrating CPAP, bilevel positive airway pressure, adaptive servoventilation, and volume-assured pressure support 2.
- A study on pediatric patients with asthma found that using a higher IPAP, low EPAP with longer I:E ratio optimizes the patient's BiPAP settings and shows significant improvement in asthma severity score, respiratory rate, and tidal volume 3.
- However, another study on patients with COPD found that BiPAP with a standard exhalation valve does not improve maximum exercise capacity, and may even increase dyspnea and reduce peak exercise workload 4.
- The timing of BiPAP application can also impact patient outcomes, with early application (within one hour of admission) resulting in a shorter length of emergency room stay in patients with pulmonary edema 5.
Key Considerations for BiPAP Setting Adjustments
- The patient's specific condition and needs should be taken into account when adjusting BiPAP settings, such as the presence of congestive heart failure, type 1 or type 2 respiratory failure, or asthma 3, 5.
- The use of proprietary algorithms from different manufacturers should be considered, as well as the patient's comfort and tolerance of the BiPAP settings 2.
- Regular monitoring and adjustment of BiPAP settings may be necessary to optimize patient outcomes and minimize adverse effects 6, 4.