A patient on bi-level therapy shows signs of hypoventilation. What adjustment should be made?

The appropriate response for a patient on bi-level therapy who shows signs of hypoventilation would be to increase the inspiratory pressure (IPAP), rather than decrease the expiratory positive airway pressure (EPAP). Hypoventilation indicates that the patient is not moving enough air, which often requires enhanced ventilatory support.

In bi-level therapy, IPAP is responsible for assisting with inspiratory effort and increasing tidal volume. By increasing IPAP, you enhance the pressure delivered during inhalation, which improves ventilation and helps eliminate carbon dioxide buildup.

On the other hand, decreasing EPAP could further compromise the patient's ability to ventilate by reducing the back pressure that is important for maintaining lung expansion and preventing atelectasis. Therefore, the adjustment to decrease EPAP is not beneficial in this scenario, as it could potentially worsen hypoventilation rather than improve it.

For optimal treatment, increasing both IPAP and potentially EPAP (if needed) would maintain or increase airway pressure, fostering better ventilation and oxygenation. Thus, adjustments that involve increasing the inspiratory support are preferred in cases of hypoventilation.