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Monday, January 14, 2013

When do you adjust IPAP and EPAP?

Your question: I have a question about adjusting IPAP and EPAP.  How do I know when I need to adjust both?

My answer: Think of it this way:

1.   IPAP is the same as Pressure support = increased ventilation = blow off more CO2

2.  EPAP is the same as PEEP/CPAP = increased FRC = increased oxygenation

So when you want to blow off CO2 you increase IPAP, and when you want to increase oxygenation you increase EPAP

Normal starting settings are IPAP 10 EPAP 4


Dan the Man said...

You can use the protocols for the set up, however, back in the years I developed a CPAP nebulizer and you could actually hear the lung fields open up and you dialed in more resistance. I have not patented the device yet, but it is coming. My nebulizer does not use extra lines to create the pressure – it is purely physical.

So, to answer the question without having to get blood gases, look at your patient for signs of comfort and listen to the posterior lung fields. Once you hear air movement and the patients Work of Breathing is lessened, you are in the ballpark.

Anonymous said...

Rick, I am a student starting my second year and am in my critical care clinicals. Do you know of any good mechanical vemtilation simulators online that might help me to get a better grasp of making adjustments? Thanks! Tim in Missouri

Anonymous said...

Hey Tim, the Drager site actually has an awesome simulation! check it out