What are initial inspiratory positive airway pressure (IPAP) or expiratory positive airway pressure (EPAP) settings in noninvasive ventilation (NIV)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Initial IPAP/EPAP settings are as follows:

  • Start at 10 cm water/5 cm water

  • Pressures less than 8 cm water/4 cm water not advised as this may be inadequate

  • Initial adjustments to achieve tidal volume of 5-7 mL/kg (IPAP and/or EPAP)

Subsequent adjustments based on arterial blood gas values are as follows:

  • Increase IPAP by 2 cm water if persistent hypercapnia

  • Increase IPAP and EPAP by 2 cm water if persistent hypoxemia

  • Maximal IPAP limited to 20-25 cm water (avoids gastric distension, improves patient comfort)

  • Maximal EPAP limited to 10-15 cm water

  • FIO2 at 1.0 and adjust to lowest level with an acceptable pulse oximetry value

  • Back up respiratory rate 12-16 breaths/minute


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