What is the typical starting setting for Expiratory Positive Airway Pressure (EPAP) in noninvasive ventilation?

The typical starting setting for Expiratory Positive Airway Pressure (EPAP) in noninvasive ventilation is generally around 4 cmH2O. This level is chosen as it strikes a balance between providing enough pressure to help maintain airway patency and reduce the work of breathing, while not being excessively high, which could lead to discomfort for the patient or potential adverse effects.

At 4 cmH2O, the EPAP helps to increase end-expiratory lung volume and improve oxygenation by preventing the collapse of the alveoli during exhalation. This setting is commonly used in patients with conditions like obstructive sleep apnea or in the management of respiratory failure, making it a standard starting point in clinical practice. The pressure can then be adjusted based on the patient’s tolerance, clinical response, and any monitoring results.

Starting with a lower EPAP setting allows for patient comfort and minimizes the risk of air trapping or barotrauma in patients who may not tolerate higher pressures initially.