Page 239 - Clinical Application of Mechanical Ventilation

Noninvasive Positive Pressure Ventilation 205

TABLE 7-6 Procedure to Titrate Bilevel Positive Airway Pressure

1. Set mode: spontaneous/timed.

2. Start the IPAP at 8 cm H O and the EPAP at 4 cm H O.
2
2
3. Set IPAP maximum time 0.15 to 0.25 sec longer than the patient’s actual inspiratory time. IPAP
maximum time should not be set longer than 50% of the respiratory cycle.

4. Attach mask to patient, ensure proper fit, and start machine.
5. Increase IPAP in 1 to 2 cm H O increments to provide more ventilatory assistance and larger
2
tidal volume.

6. Increase EPAP in 1 to 2 cm H O increments to improve oxygenation or to relieve upper airway
2
obstruction.
7. If poor synchronization occurs, check for leaks or alter IPAP maximum time to improve syn-
chronization.

8. Use supplemental oxygen if baseline saturation remains low with appropriate IPAP and EPAP
settings.
9. Do not increase IPAP or EPAP level beyond patient tolerance.

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Bi-flex™

Bi-Flex™is a method of delivering bilevel PAP in which the airflow during inhalation
and exhalation is “softened.” This makes breathing more natural and comfortable for
the patient. This mode provides pressure relief at the end of inhalation and the start of
exhalation (Figure 7-6). Three levels of patient-adjustable Bi-Flex™ (1, 2, 3) are avail-
able and each higher level provides progressively increased pressure relief.

Bi-level
1
2
3
Bi-Flex™
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Figure 7-6 Bi-Flex™ provides pressure relief at the end of inhalation and the start of
exhalation. Level 3 provides the highest level of pressure relief as indicated by the pressure
drop below the baseline pressure.

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