When is a Bi-Level Ventilation used?

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Bi-level ventilation

Mechanical ventilation is a technique to automatically aid or replace spontaneous breathing. Biphasic positive airway pressure ventilation, also known as BIPAP, is a is non-invasive, pressure-controlled ventilation, which allows unobstructed spontaneous breathing throughout the respiratory cycle. BIPAP provides airway support by blowing air into the airway, through a mask covering the nose. The pressure increases when the patient inhales and decreases when they exhale, making it easier for patients who have difficulty breathing impulsively at their own rate. BIPAP will rest the respiratory muscles and decrease the effort of breathing. Bi-level ventilation is used to treat sleep apnea in children. Based on the precise requirements of the patient, bi-level may be favored over continuous ventilation. BIPAP is easily tolerated by some people and also much better than continuous ventilation at treating specific medical conditions. Currently, patients with chronic respiratory failure are commonly treated with non-invasive bi-level positive airway pressure ventilation, supporting spontaneous breathing.


What is Non-invasive ventilation?

Noninvasive ventilation, refers to the administration of ventilatory support without using an invasive artificial airway such as the endotracheal tube or tracheostomy tube. The use of noninvasive ventilation has  increased over the past two decades, and noninvasive ventilation has now become an integral tool in the management of both acute and chronic respiratory failure,bothat home and critical care unit. Noninvasive ventilation has been used as a replacement for invasive ventilation, but its flexibility also allows it to be a valuable complement in patient management.


How does Bi-level ventilation work?

  •  BIPAP involves the use of a mask and a Bi-Level device.
  •  The Bi-Level device delivers pressure by means of the mask to the airway and lungs.
  •  This opens the airways to allow normal breathing to occur.
  •  Normal breathing is crucial, since it helps deliver oxygen and get rid of carbon dioxide.
  •  The pressure in Bi-Level therapy is delivered at 2 levels - inhaling (breathing in) pressure and exhaling (breathing out) pressure.
  •  The pressure increases while breathing in, and decreases while you breathing out, making breathing easier.


What are the symptoms of sleep disorder?

  • Generally, if a child has a breathing disorder named “Central Sleep Apnea (CSA)”, his/her body “fails to remember” to breathe at the time of sleep.
  •  If the breathing disorder named “Hypoventilation” occurs, then the child cannot take sufficient deep breaths to fully oxygenate his/her body.
  •  Due to these reasons, child will suffer from daytime symptoms such as headache, tiredness, nausea, loss of concentration, irritability .These are all the symptoms of sleep disordered breathing.


How can a child with sleep disorder be benefited by BIPAP?

  • A child with sleep disorder may be asked to undergo a sleep study performed during an overnight visit to hospital which measures different body functions, such as breathing pattern and heart rate.
  •  This provides more information about the child’s sleep quality and breathing pattern.
  •  Depending on the results of the sleep study, the medical professionals treating the child will decide whether or not the child may be given Bilevel Ventilation.
  •  CSA and hypoventilation are only a problem when the child sleeps. So, the child may have to use the machine when he/she sleeps.
  •  Bi-Level provides pressure throughout the night to prevent airways closing and to rest respiratory muscles and reduce the work of breathing. If it is properly used every night, the child’s sleep quality and daytime symptoms will get better.
  •  If your child sleeps during the day it is also vital to use Bi-Level for these naps.


How long will a child need to use Bi-Level Ventilation?

Generally, Bi-Level therapy is a prolonged treatment. So, it is vital to have regular follow-up appointments with the Sleep/Respiratory Doctor. The child will also need to have standard sleep studies to observe their improvement.


How to make the children understand about BIPAP?

Various methods should be used for children of different age groups:

  • Infants often can be more difficult to handle. They refuse to wear the mask or may get scared by it. If they are scared when the pressure begins, the child’s mom or dad can wait till the child fall asleep with the mask on and then can start the pressure once the child is asleep.
  •  Babies often don’t understand what Bilevel ventilation is, so one can just place the mask on the child at bedtime.
  •  Bilevel Ventilation can be explained to bigger children, and it is vital that those around them are encouraging and supportive.
  •  Teenagers can be uncomfortable to use BIPAP when staying over with friends. Based on the medical advice, he/she can have a night-off to their treatment.
  •  Above all, making sure that a mask is in best fit and preventing the mouth leaks can resolve many issues.


How to get the mask and machine?

  • The Children's Hospital has a limited supply of Bi-Level devices.
  •  Also, one can rent or purchase the device from a specific company.
  •  Various companies include: Air Liquide, ResMed, Mayo Health Care (Sleepezy) and CPAP Australia.
  •  Some families may be eligible for funding through a funding scheme.
  •  For continuous use of more than 3 months one may have to purchase a mask for the child.


What is the cost of the mask?

The average cost of the mask can be anywhere between $180 to $260.

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