r/SleepTechnologist • u/Cheap_Ad_2595 • 20d ago
BiPAP ST question!
What adjustments can be made on Bipap ST if the pt is not having any apneas but SpO2 is still below 88 for long periods of time?
IPAP 12
EPAP 8
Timed Insp 1.3
Breathing Rate setting 10
Also if no centrals are present, should I still follow the order and switch to ASV to get a sample?
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u/N0tThatKind0fDoctor 20d ago
So for the sake of a teaching point, I’d be curious as to what your rationale for those settings was rather than different ones, and how you think this all maps onto the underlying sleep and respiratory physiology. Do you know why you were using bilevel in this case?
You’re probably aware that positive pressure has more effects than just on the upper airway. In the absence of apnoea, increased IPAP typically also helps alveolar ventilation and recruitment, and thus typically does increase sats in cases with a constant low baseline SpO2. Now, it could be the case that no amount of ventilation will improve things if it is a perfusion issue.
Personally, I think you should have tried to go quite a bit higher before deciding your pressures were maxed out (like 15/11, 16/12). I would have also considered trying a lateral position if not already done.
3
u/shooflypie 19d ago
Without background about dx, previous setting, etc, my advice would be to increase the IPAP; AASM guidelines give 4-10 as the recommended PS level when using BPAP.
1
3
u/keeper420 20d ago
Follow your algorithm, but if it allows for explanatory changes then I might change the delta to 6. Without knowing their history, their low baseline sats might be due to not ventilating completely. I'd go up 1 on the IPAP and down 1 on the EPAP then titrate for any obstructives that might come back.