When starting NPPV, how should the settings initially be approached?

Establishing the pressure settings for noninvasive positive pressure ventilation (NPPV) requires a methodical approach to ensure patient comfort and effective ventilation. The recommended practice is to first set the inspiratory positive airway pressure (IPAP) before adjusting the expiratory positive airway pressure (EPAP).

Starting with IPAP allows the clinician to ensure that sufficient pressure is provided for inspiration, which directly affects the patient’s tidal volume and minute ventilation. This is crucial for addressing the immediate need for adequate gas exchange. Once the desired level of inspiratory support is established, the next step is to adjust EPAP, which serves to maintain airway patency and improve oxygenation. Setting EPAP first could lead to insufficient tidal volumes if not followed by adequate IPAP settings, resulting in ineffective ventilation.

This sequence helps to create a balanced approach to treatment, prioritizing the inspiratory support needed to optimize ventilation while still allowing for the adjustments necessary for expiratory support.