How To Choose A COPD Ventilator For Family

With the advent of high-tech bi-level ventilators (bipap), the diagnosis of non-invasive artificial ventilation (NIV) at home for COPD patients has expanded. Modern devices are small, easy to operate and have an intuitive interface.

　　What is a COPD ventilator?

　　COPD ventilator is also called non-invasive bi-level ventilator. Non-invasive bi-level ventilator is one of the NIV methods. The term comes from the English acronym BIPAP (Bi-Level Positive Airway Pressure), a ventilator that produces two pressure levels. During inspiration, it increases to compensate for insufficient breathing and ensure oxygen supply to the lungs . When exhaling - reduce airflow resistance. The difference between inspiratory and expiratory pressures not only relieves the burden on the breathing muscles, but also increases the amount of air inhaled, improves blood oxygen saturation and restores receptor sensitivity to excess carbon dioxide.

　　BIPAP can operate in different modes. The number and characteristics of working algorithms depend on the model. The main modes are as follows:

　　The S-spontaneous ventilation mode supports the patient's natural breathing. The device detects the strength of the inhalation and increases the pressure, then decreases the pressure for a comfortable exhalation. T-forced ventilation mode provides pressure increases and decreases over time based on a given speed. The patient's breathing effort was not taken into account. S/T - Spontaneous Forced Mode focuses on natural breathing and supports each breath by increasing pressure. However, when the breathing rate falls below the set limit, it will switch to forced ventilation.

　　An important condition for BIPAP treatment to be effective is that the patient has no contraindications to NIV, including:

　　coma;

　　refuses or fails to understand and follow instructions from medical personnel;

　　lack of spontaneous breathing;

　　A life-threatening drop in oxygen levels in the blood;

　　shortness of breath (more than 30 breaths per minute);

　　a high likelihood of vomiting;

　　A lot of phlegm

　　life-threatening heart rhythm disorders;

　　Injury to the face that prevents the fitting and use of a nasal mask;

　　Acute forms of otitis media or sinusitis.

What is the difference between CPAP and BIPAP treatments?

　　In addition to BIPAP, CPAP is based on a method of continuously supplying pressure to the patient's airway through a mask under therapeutic pressure. Provide respiratory support at home. The names of the devices and their appearance are similar. But the algorithms that work and the instructions used are different. In order to avoid confusion, it is worth understanding the difference between CPAP equipment and BIPAP ventilator. Here is a topic that many patients paid more attention to during my consultation with patients. Today, I will explain it here for you.

treatment stress level

　　The fundamental difference between CPAP and BIPAP is the ability of the latter to change the airflow pressure level taking into account the breathing phase. CPAP mode assumes a constant working pressure, and cpap mode with the "ventilator pressure end release" option reduces expiratory pressure (usually by 3 cmH2O). In turn, BIPAP creates different inhalation and exhalation pressures. Therefore, it is possible to set the value of the treatment pressure during the inspiratory phase, which greatly exceeds the maximum possible value for CPAP treatment.

therapeutic task

　　The main task of the CPAP machine is to provide air at a pressure strong enough to prevent the soft structures of the pharynx from closing and causing breathing to stop. This device is primarily used for obstructive sleep apnea.

　　BIPAP devices operate according to more complex algorithms. Adjust expiratory pressure to remove obstruction (CPAP function). The second, higher pressure level helps the patient breathe deeply enough, which improves ventilation of the lungs and promotes oxygenation of the blood. The range of BIPAP devices is wider than that of CPAP. It can be used with or without obstruction if the lungs are not receiving sufficient amounts of oxygen for complete gas exchange.

Type of nasal mask

　　The patient's breathing characteristics and personal preferences should be considered when selecting an oronasal mask. However, if a compact full nasal mask or nasal pillow is more commonly recommended for CPAP treatment, then for NIV in BiPAP mode, it is more convenient to use a full face mask due to the high treatment pressure values.

　　Benefits of BIPAP

　　BIPAP has many advantages over CPAP:

　Not only does airway obstruction be eliminated, but it increases the amount of air inhaled, saturating the blood with oxygen and removing carbon dioxide.

　　Allows you to maintain the patient under a higher treatment pressure than CPAP treatment.

　　Reduces the burden on the breathing muscles: it facilitates inhalation and does not cause difficulty during exhalation.

　　Provides an opportunity to choose the best treatment option based on the patient's needs and taking into account their diagnosis.

　　Allows extremely precise synchronization of the device with the patient's breathing.

　　Provides a more comfortable environment for resting at night.

　　But BIPAP cannot be considered better than CPAP. For each device, there is a range of diseases, and in treatment, the therapeutic potential of the device should be revealed as fully as possible.

　　Side effects of BIPAP therapy

　　NIV in BiPAP mode has some inconveniences. Most side effects are related to wearing an oral and nasal mask.

　　It may take a while to get used to the mask.

　　The nasal mask covers an important part of the face. This can lead to anxiety attacks in claustrophobic patients.

　　An improperly adjusted headband can pinch or chafe the skin attached to the mask.

　　An improperly sized mouth-nose mask may cause air leaks. This reduces the effectiveness of the treatment and may lead to irritation of the mucous membranes of the eyes.

　　Air leaks can increase the noise level of the machine, making it difficult to fall asleep quickly.

What is BIPAP?

　　Basic and automatic

　　The basic BIPAP model injects air into the mask at a strictly set pressure - inhaling is one thing, exhaling is another. However, depending on sleep stage and body position, the patient's stress requirements will vary slightly. The automatic device analyzes the sleeper's breathing and provides an air supply that deviates very little from the baseline, thus increasing the comfort of resting at night. At the same time, it is important to understand that automatic adjustment of air flow is not suitable for all diagnostics.

　　Accessories for BIPAP devices: everything you need for comfortable therapy

　　Accessories make BIPAP more comfortable and also allow you to use your NIV device not only at home, but also on the go. You can purchase the following related products.

　　humidifier. Breathing warm and humid air is easier and more pleasant than dry and cool air. Moisturizers can eliminate many side effects of treatment, such as dryness of the nasopharyngeal mucosa and the resulting sore throat and cough.

　　converter. The device can be used with current transformers regardless of the supply voltage. This is important if you travel a lot. Using the converter, you can connect the BIPAP machine to a car's cigarette lighter socket or train, bus and plane sockets.

　　filter. The filter removes mechanical impurities (animal hair, dust) from the blown air, thus reducing the risk of allergies. It should be replaced when dirty, but at least as recommended by the manufacturer.

　　hose. You can choose a longer hose or replace the standard model with a heated hose. In the latter case, the humidifier will maintain the optimum temperature and humidity regardless of the environmental conditions. This will eliminate the risk of condensation forming in the mask or hose.

　　Australian company ResMed provides home BIPAP machines and servo fans. The device is reliable and has an easy-to-understand Russified interface, which is important for medical care-free treatment. The device software allows specialists to remotely monitor the course of treatment and assess the effects of treatment.

　　BIPAP units are equipped with a built-in humidifier with automatic climate control to maintain the selected supply air temperature and humidity. Models can be additionally equipped with accessories, incl. The introduction of innovative technologies such as pulse oximetry sensors and modules for monitoring oxygen saturation have brought the ResMed Lumis range to a higher level of quality and comfort. All of this is easy to use due to the high synchronization between the device and the patient's breathing. This speeds up adaptation to treatment and improves treatment efficacy. The main difference between the offered devices is the number of operating modes and the list of diseases for which they can be used.

Lumis 150 VPAP ST（ResMed）

　　This model has advanced features: it operates in 4 standard modes (CPAP, S, T, ST) and has 2 auxiliary algorithms (PAC, iVAPS). It has a smart iVAPS mode, so it is different from other models in the Lumis range.

　　The goal of iVAPS is alveolar ventilation. General ventilation takes into account the air in the respiratory tract. This is called a dead zone, because a given volume of oxygen does not participate in gas exchange in the alveoli. In turn, alveolar ventilation reflects the available volume of respiratory mixture reaching the lungs. This mode maintains the effectiveness of respiratory support regardless of the patient's breathing rate.