NIV, or BiPAP, is a common therapy in critical care medicine. In the right patient population, it can be used instead of invasive ventilation and keep patients off mechanical ventilators. It is important to ensure you are picking the right patient as NIV in the wrong setting will not only be unsuccessful but can also put the patient at risk for aspiration. The classic NIV patient is alert with an intact drive to breathe. They either need some help with distending pressure or assistance with augmenting their tidal volumes with some extra support. Choosing initial settings on BiPAP is straightforward once you identify the therapy that is most beneficial to your patient.


Non-invasive ventilation (NIV) is preferred to invasive ventilation, but only when the conditions are met. An ideal NIV patient is breathing on their own, fairly alert, and not at risk for aspiration. At the same time, the patient must have a need for distending pressure (EPAP/PEEP) or supportive pressures (IPAP/PS). When NIV is used in hospital, that means BiPAP, as CPAP is not a true form of ventilation.

Initiating non-invasive ventilation is very similar to how you approach setting up PSV for a spontaneously breathing patient. There are three main settings that need to be adjusted as well as one additional “back-up” setting. First, you will set the oxygen delivery (FiO2), a distending pressure to help recruit alveoli (EPAP), and a high pressure to augment the patient’s normal breath (IPAP). The back-up setting is a basic RR (remember, this setting does not replace the patient spontaneously breathing). Then, the efficacy of NIV is checked after 30 minutes with an arterial blood gas.


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