Oxygen Therapy with ResMed BiPAP Devices
Introduction to Oxygen Delivery
- The American Academy of Sleep Medicine recommends that the maximum oxygen bleed that can be safely used with a ResMed BiPAP device is typically 10-15 L/min, though this should be carefully monitored as higher pressure settings will reduce the effective oxygen concentration delivered to the patient 1, 2
- Oxygen can be added to BiPAP circuits through a T-connector between the device outlet and the hose, allowing supplemental oxygen to enter through the side arm 1
- The effective fraction of inspired oxygen (FiO₂) for a given supplemental oxygen flow rate decreases as IPAP or EPAP pressures increase due to increased intentional leak 1
- FiO₂ does not appear to vary with the amount of pressure support or respiratory rate 1
Optimal Oxygen Administration
- The American Academy of Sleep Medicine suggests that oxygen should be connected to the PAP device outlet using a T-connector for optimal mixing and to provide a reservoir of enriched gas 1, 3
- Supplemental oxygen should be initiated at 1 L/min for both pediatric and adult patients 3, 4
- Oxygen flow should be increased by 1 L/min at intervals no shorter than 15 minutes until SpO₂ is between 88% and 94% 3, 4
- A slightly higher SpO₂ goal of 90-94% might be prudent in some circumstances due to potential overestimation by pulse oximetry 1
Pressure Settings and Oxygen Interaction
- Higher IPAP and EPAP settings reduce the effective oxygen concentration for a given flow rate 1
- Recommended minimum starting IPAP and EPAP should be 8 cm H₂O and 4 cm H₂O respectively 5, 6
- Maximum IPAP should be 30 cm H₂O for patients ≥12 years and 20 cm H₂O for patients <12 years 5, 6
- Minimum pressure support (difference between IPAP and EPAP) should be 4 cm H₂O 7