Positive airway pressure adjustment in acute decompensated obesity-related respiratory failure. Positive airway pressure adjustment in acute decompensated obesity-related respiratory failure. The adjustment of continuous positive airway pressure/expiratory positive airway pressure (EPAP) has the objective of eliminating obstructive events, snoring and intermittent oxygen desaturations. Adjustments in inspiratory positive airway pressure (IPAP) are aimed at eliminating hypoventilation and sustained hypoxaemia. For both EPAP and IPAP, the pressure should increase progressively until attaining the objectives (resolution of upper airway obstructive events and sleep hypoventilation) or until the maximal tolerated pressure is reached. Alternatively, EPAP/continuous positive airway pressure can be adjusted to eliminate obstructive apnoeas and IPAP can be further increased to eliminate obstructive hyponoeas, snoring and hypoventilation. With this strategy, the patient may require lower EPAP and therefore achieve higher levels of pressure support in order to improve hypoventilation [96]. Supplemental oxygen is habitually added to positive airway pressure therapy when an adequate oxygenation level is not achieved despite adequate titration of positive airway pressure therapy. NIV: noninvasive ventilation; PaO2: arterial oxygen tension; SaO2: arterial oxygen saturation. Juan F. Masa et al. Eur Respir Rev 2019;28:180097 ©2019 by European Respiratory Society