What is the recommended starting pressure for pediatric and adult CPAP titration?

The recommended starting pressure for CPAP titration in pediatric and adult patients is 4 CMH2O. This pressure is considered effective for initiating treatment as it is generally low enough to allow for adaptation while still sufficient to prevent airway collapse in patients who require continuous positive airway pressure (CPAP) therapy.

Starting at this level is also beneficial as it provides a balance between being minimally invasive and providing the necessary support for the patient's respiratory needs. If patients tolerate this starting pressure but still exhibit signs of obstructive sleep apnea or hypopneas, the pressure can then be gradually increased during the titration process to optimize treatment. The objective is to find the lowest effective CPAP pressure that alleviates respiratory events while minimizing discomfort or side effects for the patient.

Lower or higher initial pressures, such as 2 CMH2O or pressures above 4 CMH2O, may not provide clinically adequate support for many patients, reducing the effectiveness of the CPAP titration process. Thus, starting at 4 CMH2O makes sense as a solid foundation for subsequent adjustments.