Ventilator adjustment for acute noninvasive ventilation and oxygen therapy

For patients receiving acute noninvasive ventilation, adequacy of ventilation is assessed by chest expansion, repeat arterial blood gases and readings on the noninvasive ventilation device.

Generally, inspiratory positive airway pressure (IPAP) is increased in 2 to 5 cmH₂O increments every 10 minutes (or as clinically indicated) to reduce carbon dioxide until pH is corrected. Expiratory positive airway pressure (EPAP) is increased in similar increments to overcome upper airway collapse (snoring) or restrictive lung volume.

In general, maximum settings are 20 cmH₂O for continuous positive airway pressure (CPAP), 30 cmH₂O for IPAP, and 20 cmH₂O for EPAP; however, maximum settings vary, and depend on patient size and weight. There should always be a difference of at least 6 cmH₂O between IPAP and EPAP.

See Inadequate ventilation for considerations in patients who have not responded adequately to ventilation.

Give oxygen to maintain target oxygen saturation measured by pulse oximetry (SpO₂) levels; see Pulse oximetry to monitor acute oxygen therapy for target SpO₂ levels. For information on considerations in acute oxygen therapy, see Principles of oxygen therapy and Potential harms of oxygen therapy.