You CAN BiPAP at low settings

I am so tired of my coworkers telling me that the BiPAP settings must be greater than the following to be effective:

• IPAP = 10
• EPAP = 4

They say, and so do the BiPAP sales people, that when these settings are reached by the patient, the BiPAP is no longer needed.  

I beg to differ.  My main reason is that you cannot just make up a number and say that that number is ideal for every person.  I can say this, and no one can debate me on it, because every person is different.  

For example, yesterday I had an end stage pulmonary fibrosis patient, and her spo2 was dipping into the 70s on an NRB.  Other than that her blood gases were okay.  What she needed was some mechanism to keep her alveoli open.  I set up the BiPAP at 10/4.  Her sat shot up to 99%. Her tidal volumes were 700.  This was perfect for her.  

So my coworker came in and I gave him report on this patient.  He said, "So, then it's time to take the BiPAP off her if that's all she needs."  

I said, "I'm tired of people telling me that."

He grumbled and griped

I said, "I took her off so she could eat, and her sat dipped to the 70s.  She begged to go back on.  If you want to take her off because she doesn't need higher settings, be my guest.  If you want to increase her settings and force more air into her than she needs, be my guest." 

He grumbled and griped.  

If 10/4 is all that's needed to improve ventilation and/or oxygenation, more is not needed.  

There may be studies that show otherwise, but no study will ever compensate for common sense, at least in my book.  

Related: 

• What BiPAP settings are best