- For patients with suspected ACPE its reasonable to set the CPAP pressure at 10cm H2O. This pressure can be adjusted up or down depending on patient comfort.
- Oxygen should be titrated based on PCO2, PaO2 and titrated to the patient SpO2 at the bedside.
BiPAP:
- For patients receiving BiPAP start with an IPAP of between 12-15cm H2O, and and EPAP of between 4-7cm H2O.
- These pressure can be titrated up or down depending on the combination of clinical effect as well as patient comfort.
- Failure to improve oxygenation should prompt sn increase in fractional inspired oxygen and EPAP.
- Failure to improve the hypercarbia should lead to an increase in IPAP.
Take Home Points:
- Based on current evidence pressures should not exceed 25cm H2O at any point regardless of the mode of NIV being used.
- In order to maintain the pressures, it is important to achieve a good seal with the NIV mask.
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