NIPPV Settings

Non-invasive positive pressure ventilation (NIPPV) is a mode of ventilation utilized in the setting of acute asthma exacerbation which can reduce work of breathing and potentially stent open the lower airways.

It is used for the treatment of critical asthma to decrease work of breathing and improve ventilation. It is considered a temporizing measure while preparing for intubation in patients that are unresponsive and/or have rising CO₂.

Initiation

Start BiPAP at moderate settings of 10/5 cm H₂O with supplemental oxygen administration to keep SpO₂ > 92%. The multidisciplinary critical care team may escalate settings frequently in an effort to reduce work of breathing.

De-escalation

De-escalate in a stepwise fashion highest tier down to tier 1. Patients do not need to transition to CPAP prior to discontinuation on NIPPV for asthma. They can come directly off from Step 1.

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.