[MM2007]

Hello, how do you know what IPAP AND EPAP pressure is right for the patient, recently i nursed a patient on 18/6, but how do you come to decide that thee are the right pressures for the patient.

Thanks

[COMEBACKDAD]

Im sure there are other factors, but breath sounds and o2 sats will usually give you a good idea if your close. I would assume these were Dr. ordered pressures or does someone else like a repiratory therapist set those in the UK?

[All_Smiles_RN]

We take bipap on our floor for ventilation and OSA. MD and RT collaborate to figure out the settings. I've noticed them adjust based on ABG trends.

[scattycarrot]

We don't have respiratory therapists in the uk unfortantly, they sound like agood addition to the healthcare team.
Anyway, in my experience BIPAP settings are changed or set according to ABG's and the patients reponse to treatment.

[grace90]

[quote=scattycarrot;2252393]We don't have respiratory therapists in the uk unfortantly, they sound like agood addition to the healthcare team./QUOTE]

They are worth their weight in gold!

[Agnus]

ABGs are used to determine setting. Seldom does the RN have to do this in the USA

[RRTM2]

IPAP = ventilation.
Higher settings increase the tidal volume, which lowers C02 levels.

EPAP isn't exactly PEEP but you can think of it that way. It's a lower amount of positive pressure keeping the lungs open. (or positive pressure for CHF... depending on the application). Usually set at 5 or 6... it won't change much.

Like everyone has said... settings change per ABG results.
Or pt tolerance. An IPAP of >20 and the pt might as well hang their head out the window going down the track at NASCAR.

[AliRae]

Yup to what's been said. We'll change our settings also without drawing blood (often a tricky thing to do in the kiddos depending on access) ... I had a kid today who we were just trending based on respiratory effort and lung sats. Generally it's the respiratory therapists who will recommend settings to the docs, but if I know a kid I'll jump right in.

And as for an IPAP of above 20 being like nascar? I had a kiddo recently on 20/12 nonstop for over a month. When we finally took him off, he had a hole worn into his palate. (Picture blowing a hairdryer at the roof of your mouth full blast for weeks on end.) Poor little love.