BiPAP Auto protocol

---

BiPAP Auto protocol

Patient types

Restrictive disorders (e.g., kyphosis or fibrosis) Neuro-muscular disorders and SDB

Obesity hypoventilation

OSA

COPD

Complex SDB

Periodic breathing

• Bi-level therapy provides two independently set pressures to maintain airway stability and support ventilation requirements while the patient sleeps: – Inspiratory Positive Airway Pressure (IPAP) is the higher pressure. This pressure is applied during inspiration and can augment the patient’s tidal volume. – Expiratory Positive Airway Pressure (EPAP) is the lower pressure. This pressure is applied during exhalation. It can provide upper airway stability or increase the patient’s Functional Residual Capacity (FRC).

© 2012 Koninklijke Philips Electronics N.V. All rights are reserved. edoc WMB 11/12/12 MCI 4105370

• BiPAP Auto is another form of BiPAP S • BiPAP Auto can aid in the titration process: – Addressing possible changes in pressure throughout a given night or from night to night. – Improve patient comfort. – If unable to complete the titration night.

Suggested titration protocol for BiPAP Auto mode GOAL: Adjust user-set parameters for optimal efficacy and adherence

Acclimation zone

Switch mode to BiPAP Auto

• Establish initial settings as indicated or as ordered by physician • Ensure proper mask fit to enhance patient comfort and acceptance, and to minimize leaks • Have patient breathe on BiPAP device at basic settings to the right • Recheck mask fit, assure patient comfort and acceptance

• May adjust IPAP, EPAP and Bi-Flex to patient comfort * For patients who could not fall asleep on CPAP, increase IPAP to 8 cm H2O and maintain EPAP at 4 cm H2O1 * If patient has known CPAP pressure of < 10 set min EPAP at 4 cm H2O and PSmin at 4 cm H2O or patient comfort * If patient has known CPAP pressure of > 10 set min EPAP at 6-8 cm H2O and PS min at 4 cm H2O or patient comfort 1

MaxIPAP MinEPAP PSmin PSmax Bi-Flex

J. Clin. Sleep Med. 2008; 4(2):151-171

25 cm H2O 4 cm H2O 4 cm H2O 8 cm H2O To patient comfort

H

Monitor patient PSG Wait. . . . Watch. . . . Observe. . . . Think Patience is the key to successful titration Observe for patient’s inability to maintain sleep due to severe obstructive apneas

and

If no

If yes

If yes Titration zone

Observe for mask leaks

For patient comfort and to allow sleep onset, increase min EPAP by 1 cmH2O to open airway

Leak: fix mask leak

H

H

Return to

Return to

If

Prescription zone

Patient cannot tolerate pressure, try different Bi-Flex settings

BiPAP Auto prescription MaxIPAP = ______ cm H2O PSmin = ______ cm H2O MinIPAP = ______ cm H2O PSMax = ______ cm H2O Bi-Flex = ______ Interface: _____________________________________________

Observe for central apneas/ hypopneas If yes

If central apneas/ hypopneas persist, consider retitration with BiPAP autoSV Advanced or BiPAP AVAPS

If no