What is a potential complication when setting IPAP greater than 20 cm H2O?

Setting the Inspiratory Positive Airway Pressure (IPAP) greater than 20 cm H2O can lead to gastric distension as a potential complication. This occurs because high levels of airway pressure can encourage air to be forced into the stomach. With insufficient exhalation time or if the patient is not effectively managing their own exhalation, the pressure can also lead to the swallowing of air, further contributing to distension.

Gastric distension can result in discomfort, potential vomiting, and may even lead to complications like aspiration if the vomitus is inhaled. It is important to monitor the patient closely for signs of abdominal bloating and ensure that IPAP levels are set in a manner that promotes effective ventilation while minimizing such risks.

While hypoxemia, bradycardia, and atelectasis are relevant considerations in critical care, they are not specifically associated with high IPAP settings in the same direct manner as gastric distension. Each of these conditions has other underlying mechanisms and causes that would not necessarily be exacerbated solely by elevated IPAP pressures.