Chart — Mechanical Ventilation
NIV Settings Chart
Noninvasive ventilation works when the interface, mode, and starting pressures fit the problem. This chart pairs the scenarios RTs see most with sensible starting settings, what to titrate, and the goals that tell you it is working — all pressures in cm H₂O.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Starting Settings by Scenario
| Scenario | Interface / Mode | Initial Settings | Titrate For | Goals & Reassessment |
|---|---|---|---|---|
| COPD exacerbation with respiratory acidosis | Bilevel | IPAP 10 (8–12), EPAP 4–5, FiO₂ to SpO₂ 88–92% | ↑ IPAP for CO₂ / VT | pH and RR improving on a 1–2 h gas |
| Cardiogenic pulmonary edema | CPAP 8–12 or bilevel | FiO₂ to SpO₂ ≥ 92% | Pressure for work of breathing | Preload / afterload relief, SpO₂, RR |
| Obesity hypoventilation | Bilevel | Higher EPAP needs 6–10, IPAP for ventilation | EPAP for upper airway, IPAP for CO₂ | Nocturnal adherence, daytime CO₂ |
| Post-extubation prevention (high-risk) | Bilevel or CPAP early after extubation | Modest pressures | Comfort / tolerance | Avoid reintubation — prevention beats rescue |
| Immunocompromised acute respiratory failure | Bilevel per team | Gentle pressures | Oxygenation | Early escalation decision |
Clinical Notes
- Pressure support = IPAP − EPAP. Raising EPAP alone narrows the support and can drop tidal volume — if you raise EPAP for oxygenation or the upper airway, raise IPAP with it to hold the difference.
- Mask fit is the therapy. Recheck fit, leak, and skin at every assessment; an unmanaged leak undoes the pressures you set and threatens the eyes and bridge of the nose.
- Respect the contraindications. Cardiac or respiratory arrest, an inability to protect the airway, active vomiting, and hemodynamic instability all argue against NIV.
- Never delay a needed intubation. NIV buys time when it is working; a patient who is not improving on a 1–2 hour reassessment needs escalation, not more time on a failing trial.
Related Resources
Sources
- Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.