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Favorite bipap settings?


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I've been using bipap a lot more lately and the patten I have gotten into is this:

severe resp. distress 18 pressure support, 8 peep, 40% to start

mod resp distress 14 pressure support, 4 peep, 30% to start

what do you folks do?

 

Any respiratory issues I always start out IPAP of 10 & EPAP of 5 with 40-50% O2. Look at patient/tidal volumes/total leak for the first minute or two. Then adjust FIO2 within that 1-2 min time frame to get a good SpO2 (but usually CPAP/BiPAP will increase their SpO2 greatly). I then adjust the IPAP/EPAP according to their flow demands or oxygenation demands. If need more Vt (tidal volume) then increase PS (pressure support) going to IPAP of 12 or 14 and keeping EPAP at 5. If the patient has oxygenation issues or needs more peep then keep the PS the same, but raise the peep (EPAP) going to IPAP of 13 and EPAP of 8 = PS 5. I try not to raise the O2 unless it is acute then I will let them get stable/calm and then lower the FIO2 down and if they still have an issue then I will raise the EPAP while keeping their same IPAP. I hope your pressure support of 14 or 18 is the IPAP (which is high in my eyes), but if you put someone on IPAP 19 and EPAP 5 = PS of 14 then I don't know how they keep that face mask on without breaking their skin down. 10/5 (IPAP/EPAP) is very standard start that will give most people a Vt of 500 ml. Also, I never go below an EPAP (peep) of 5 because physiological peep is 5 and if someone puts a patient on a non-invasive ventilator or an invasive ventilator with a peep of 4 you are theoretically de-recruiting their aveoli.

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I've been using bipap a lot more lately and the patten I have gotten into is this:

severe resp. distress 18 pressure support, 8 peep, 40% to start

mod resp distress 14 pressure support, 4 peep, 30% to start

what do you folks do?

 

Any respiratory issues I always start out IPAP of 10 & EPAP of 5 with 40-50% O2. Look at patient/tidal volumes/total leak for the first minute or two. Then adjust FIO2 within that 1-2 min time frame to get a good SpO2 (but usually CPAP/BiPAP will increase their SpO2 greatly). I then adjust the IPAP/EPAP according to their flow demands or oxygenation demands. If need more Vt (tidal volume) then increase PS (pressure support) going to IPAP of 12 or 14 and keeping EPAP at 5. If the patient has oxygenation issues or needs more peep then keep the PS the same, but raise the peep (EPAP) going to IPAP of 13 and EPAP of 8 = PS 5. I try not to raise the O2 unless it is acute then I will let them get stable/calm and then lower the FIO2 down and if they still have an issue then I will raise the EPAP while keeping their same IPAP. I hope your pressure support of 14 or 18 is the IPAP (which is high in my eyes), but if you put someone on IPAP 19 and EPAP 5 = PS of 14 then I don't know how they keep that face mask on without breaking their skin down. 10/5 (IPAP/EPAP) is very standard start that will give most people a Vt of 500 ml. Also, I never go below an EPAP (peep) of 5 because physiological peep is 5 and if someone puts a patient on a non-invasive ventilator or an invasive ventilator with a peep of 4 you are theoretically de-recruiting their aveoli.

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  • 4 weeks later...
I just listened to a great EMCRIT podcast on Non-Invasive Ventilation. He breaks it down concisely with some nice analogies to hair dryers and sticking your head out the window of a moving car. Anyway, all of his podcasts are incredible. The NIV podcast can be found here: http://emcrit.org/podcasts/niv/

 

That's exactly the analogy I use when putting it on the PT. Most of the time in the ER they just request to try to maintain an appropriate height based Vt and get a gas to evaluate. But 10/5 is the usual go-to around here

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