Noninvasive Positive Pressure Ventilation (NIPPV) is bilevel ventilation that provides inspiratory and expiratory support.

Noninvasive Positive Pressure Ventilation (NIPPV) is bilevel ventilation that provides inspiratory and expiratory support. Using the low to high approach to initiate NIPPV, what are the initial settings that should be ordered?

A.  IPAP 10, EPAP 5, FIO2 100%

B.  Respiratory Rate 12, Vt 500, PEEP 5, FIO2 100%

C.  IPAP 25, EPAP 5, FIO2 100%

D.  Respiratory Rate 20, PEEP 5, FIO2 100%"

Bilevel NIPPV entails the identification of starting values that need to be set in order to regulate the IPAP and EPAP though which support the patients inhaled and exhaled volumes. The settings are typically prescribed at the base and are titrable depending upon the response of the patient and the clinical scenario.

 For the low-to-high approach, the initial settings should generally be:The initial settings for low-to-high approach should be generally as following:

 PERIPHERAL: C. IPAP 25, EPAP 5, FIO2 100%

 Explanation:

 IPAP (Inspiratory Positive Airway Pressure): This is set higher in order to deliver adequate inspiratory assistance. A starting level of the pressure support of 25 cm H₂O is hence quite standard in patients who need quite a lot of help with inspiring.

 EPAP (Expiratory Positive Airway Pressure): This is set lower initially for the use of enough pressure to give support for expiration and to retain alveoli recruitment, it is set at 5 cm of H₂O.

 FIO2 (Fraction of Inspired Oxygen): It may first be given at FIO2 of 100 % and finally be reduced, needed for the most important or serious hypoxic conditions.