Which adjustment should be made for a child with cerebral palsy and sleep apnea exhibiting elevated PaCO2 during nocturnal bilevel noninvasive ventilation?

When addressing elevated PaCO2 levels in a child with cerebral palsy and sleep apnea who is receiving bilevel noninvasive ventilation, increasing the respiratory rate is the most appropriate adjustment to enhance ventilation. Elevated PaCO2 indicates inadequate carbon dioxide clearance, which is often a result of insufficient ventilation. By increasing the respiratory rate, you promote more frequent breaths, thereby increasing minute ventilation and facilitating better elimination of carbon dioxide.

In the context of nocturnal bilevel ventilation, it’s crucial to ensure that the child is adequately ventilated to maintain normal PaCO2 levels. Increasing the respiratory rate can effectively reduce CO2 retention and improve gas exchange during sleep when respiratory drive may decrease.

The other options might not directly address the underlying issue of hypercapnia. For instance, increasing EPAP can help in preventing airway collapse and enhancing oxygenation, but it may not significantly improve ventilation and reduced CO2 levels. Decreasing IPAP would reduce the pressure support provided, potentially worsening hypoventilation and increasing CO2 retention. Increasing FiO2 would primarily enhance oxygenation rather than directly aiding in the elimination of carbon dioxide. Thus, focusing on the respiratory rate adjustment is the most effective way to manage elevated PaCO2 in this scenario.