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*'''BiSoft modes''' apply a gradual ramp upto a pressure level known as '''EEPAP''' (end expiratory positive airway pressure). This end of expiration pressure is applied at the most critical time for airway collapse and provides important airway stenting, in preparation for inspiration. It can limit central apnea, round out exhalation and permit generally lower pressures.
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*You can use each Each of these the Bi-soft levels to apply the pressure rise and increased flow at incremental ratios divided between exhalation and inspiration phases. This can be leveraged to target the weakness or instability in your breathing breath shapes. If you see have good exhalation shape but late flow limitation during collapse of inspiration, you may select level 0 to apply all pressure support to that period in your breathing. As some instability become obvious at very late exhalation continuing into early/mid inspiration, you may apply level 1 or 2. This will divide the total pressure support between eepap and ipap. some to stent the late exhale and some to stent the early inhale. Level 4 (Tri-level) can be used to apply most pressure during end of expiration with only minimal pressure support for those with good collapsing exhalation and instability during time at zero before inspiration. The higher levels of Bi-soft can also be used to limit central events by reducing ventilation.
*Lowenstein recommends setup in a Bi-Level stage first, then apply '''Tri-Level''' to use their predetermined comfort 'pressure reduction'. Lowenstein recommend return to Bi-level for further adjustment.This is due to the machine adding and subtracting pressure from IPAP and EPAP with an unseen algorithm at certain pressures, which can confuse settings.
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