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

In cases of elevated PaCO2 during nocturnal bilevel noninvasive ventilation in a child with cerebral palsy and sleep apnea, increasing the respiratory rate is the most appropriate adjustment. Elevated PaCO2 indicates that the child is not adequately ventilating, leading to carbon dioxide retention.

By increasing the respiratory rate, you enhance the frequency of breaths delivered, which can effectively improve the elimination of CO2 from the body and help normalize arterial carbon dioxide levels. This change addresses the underlying issue of hypoventilation that may be present due to the neuromuscular involvement of cerebral palsy, helping to facilitate a better gas exchange during ventilation.

In contrast, the other options may not adequately address the problem. Adjusting the expiratory positive airway pressure (EPAP) or the inspiratory positive airway pressure (IPAP) without a corresponding increase in the respiratory rate could lead to further CO2 retention, particularly if the underlying issue is insufficient respiratory effort. Increasing the FiO2 may improve oxygenation but would not resolve the elevated levels of carbon dioxide since it does not directly address ventilation.