Certified Respiratory Therapist Practice Exam

During CPAP titration, how should the pressure be adjusted if a patient exhibits three obstructive apnea events in a 5-minute interval at 8 cm H2O?

1. Decrease the CPAP to 6 cm H2O

2. Maintain the CPAP at 8 cm H2O

3. Increase the CPAP to 10 cm H2O

4. Increase the CPAP to 12 cm H2O

The correct answer is: Increase the CPAP to 10 cm H2O

In the context of CPAP titration, when a patient exhibits obstructive apnea events, it is crucial to increase the pressure in order to prevent the collapse of the airway during sleep. The goal of CPAP therapy is to maintain a patent airway and eliminate episodes of apnea or hypopnea. In this scenario, since the patient has shown three obstructive apnea events in a 5-minute interval while at 8 cm H2O, this indicates that the current pressure is inadequate to keep the airway open. Increasing the CPAP pressure to 10 cm H2O helps to provide additional pneumatic support that is required to overcome the obstruction and to keep the airway unobstructed during sleep. Adjusting the CPAP to a higher level, such as to 10 cm H2O, is evidence-based strategy as it aligns with the clinical practice of escalating pressure to alleviate airway obstruction noted during the titration process. This approach is essential in finding an optimal therapeutic pressure that eliminates apnea events and improves the overall efficacy of the treatment. Maintaining the CPAP at the current level or decreasing it would not address the issue of obstruction and could potentially lead to further apnea events, thereby compromising the patient's respiratory function and health during sleep.