Your question: What are good starting BiPAP settings?
My humble answer: BiPAP is generally needed when the patient isn't taking in adequate tidal volumes to blow off CO2, or has some disease condition going on (CHF, COPD, Asthma) that the patient isn't oxygenating. The BiPAP is thus set up to improve ventilation (IPAP), improve oxygenation (EPAP), or both. The minimum settings required to obtain normal ABG values are what is needed.
The default start setting has historically been an IPAP of 10 and EPAP of 4 and to adjust accordingly. I still believe this is the best place to start on every patient. This is a good place to start because this is a minimum setting, provides low flows to the patient airway, and is the most comfortable for the patient. You can then adjust the settings as appropriate.
Many RTs say that 10/4 is not therapeutic, that is only provides normal oxygenation and ventilation. Yet I believe that if a patient isn't ventilating or oxygenating, chances are he is obtaining a lower tidal volume than normal. This is normally the case with exacerbations of asthma and COPD, asthma and CHF where the patient is pooping out. In these cases, there is no need to start higher than 10/4. Your goal is simply to give the patient a NORMAL respiration. After all, if they were generating a normal respiration on their own they wouldn't need your services.
Once you have a patient set up on 10/4, you can adjust as needed. If the patient is not blowing off enough CO2 you can increase the IPAP. If the patient isn't oxygenating effectively you can increase EPAP.
Many people say 10/4 isn't therapeutic, and they will say you should start higher. Yet I believe if a setting of 10/4 gives you a good tidal volume of 6-10cc/kg ideal body weight, then you are being therapeutic.
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