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biPAP settings

Posted: Thu Mar 17, 2016 11:49 am
by curiousgeorge
The pediatric intensivists have changed the biPAP settings from 18/4 to 20/10. Will these settings be better for my child with a respiratory tract infection?
CO2 is 35
O2 sat is 88 to 93%

(Asked by a parent)

Re: biPAP settings

Posted: Thu Mar 17, 2016 11:50 am
by bachjr
These settings are lower, not higher, because she only needs pressure when she inhales, not when she exhales so instead of helping her with 18/4 or even better, 18/0, she is only receiving 20-10 or 10 cm H2O pressure. Since the physicians do not realize that expanding the airways by administering high EPAP does not help expulse airway secretions or significantly decrease atelectasis while MIE does, they are probably not using the latter either via the invasive airway tube or via the upper airway either. Thus, they will think that tracheotomy is necessary because the child is not “weanable” and without MIE they are not clearing the airways or the pneumonia. Thus, besides less breathing support which can result in fatigue, the high expiratory pressure will be uncomfortable and less useful for “keeping the lungs open” than effectively removing airway secretions by MIE.