Bi-level ventilation

What is Bi-level ventilation?

Bilevel positive airway pressure (BiPAP) ventilation is a type of breathing support that assists your child’s ability to breathe. It uses a mask and a BiPAP ventilator. The ventilator blows pressurised air through a mask into the airway and lungs. This will open up the airway to let normal breathing to happen.

The machine helps your child’s quality of life – it is not a life support machine and will not do your child’s breathing for them. It will help your child’s breathing pattern to help your child breathe deep and fill their lungs. The BiPAP machine will deepen the breath and make sure the lungs are given enough air to let normal breathing happen.

Normal breathing is important as it lets your body take in enough oxygen, and let carbon dioxide to leave your body. The pressure increases when breathing in and the pressure decreases when breathing out. This makes breathing easier.

Why does my child need bilevel ventilation?

Your child may have had a home oximetry or a sleep study during an overnight visit to the hospital.

These measure a few body functions such as:

• breathing pattern
• heart rate
• quality of sleep

These results will have shown your child has a breathing disorder called central sleep apnoea (CSA) or hypoventilation.

In CSA the body ‘forgets’ to breathe for periods when asleep. Hypoventilation happens when your child does not breathe enough to fully oxygenate their body.

You may also have noticed that your child is suffering from daytime symptoms such as:

• headaches
• tiredness
• nausea
• loss of concentration
• irritability

These are all signs of sleep disordered breathing.

CSA and hypoventilation are only a problem when your child sleeps. For this reason your child will only need to use the machine when they are sleeping. Bilevel gives pressure throughout the night to stop the airways closing. It also lets the respiratory muscles rest and decrease the work of breathing. When used every night your child’s sleep quality and daytime symptoms should improve.

What do I tell my child about bilevel ventilation?

Explain to your child that they are using the machine at night to help them to sleep easier and this will also make them feel better during the daytime.

Your child will need to get into a routine of using their equipment all night, every night. They will need lots of support and encouragement from those around them. Support from parents and carers is the most important part to make this successful. It is recommended that you let your child wear the mask for short periods of time regularly during the first few days.

This can either be in the daytime or early evening, but should always be when there is a parent or carer there to offer support, encouragement and distraction when needed.

Who is involved in my child’s care?

A team at Sheffield Children’s hospital specialising in all aspects of sleep disordered breathing and home ventilation.

This team is made up of:

• respiratory consultants
• sleep technologists
• respiratory physiotherapists
• a respiratory physiologist
• 2 clinical nurse specialists

We provide:

• an in-hours telephone service to deal with any issues you may have
• a community nurse to provide support and assistance in your own home
• regular oximetry tests carried out at home
• a yearly overnight stay in hospital to have more detailed monitoring and equipment check
• regular clinic appointments with your consultant to monitor your child’s respiratory function

Starting ventilation

At the moment, it is better to try starting BiPAP ventilation at home rather than in a hospital. It is often less stressful for you and your child and makes it easier for your child to get used to the ventilation. However this is does depend on the severity of your child’s condition and is up to your consultant to decide.

It is important for your child to start ventilation as soon as possible. If this cannot happen at home then we will need to arrange a hospital admission to help.

Where do I get a bilevel machine and supplies?

To begin with, the hospital will give you a loan machine to borrow. This will be arranged with your local Primary Care Trust (now Clinical Commissioning Groups (CCG)). Once treatment has started, your local CCG will be responsible for replacing broken equipment and consumables. Once the team have agreed to start treatment on your child we will provide you with the following:

• a ventilator
• 2 nasal masks
• spare ventilator tubing
• spare dust filters for your machine

How do I look after the bilevel ventilation equipment?

Bilevel machine

The machine just needs wiping clean with a damp cloth. All the settings and buttons on machine are locked, so you cannot accidentally change any settings whilst cleaning machine.

If your machine has a humidifier chamber, this can be washed out with hot water and left to dry. Do not put humidifier chambers through dishwashers as this can cause them damage.

Mask, headgear and tubing

The mask and tubing needs to be disconnected and aired out daily. Wash them out regularly (once a week) by hand washing them in warm soapy water. Thoroughly rinse all the parts and leave to air-dry before using them again.

The cloth headgear is cannot be washed and spares will be given if they become soiled.

Air filter

There are two air filters on your machine. The round, bacterial air filter (at the front of the machine) should be changed at least once a month. The internal dust filter will be changed by your community nurse. Do not wash or recycle used air filters.

What if the BiPAP machine or supplies break or malfunction?

Most children will not suffer from one night without the BiPAP therapy.

However if there is a problem with the machine we need to be told as soon as possible so we can fix the fault and give you with a replacement machine.

If a problem happens within office hours please contact Lee Richardson or Amika Challacombe immediately on either the mobile or office telephone found at the bottom of this page.

If the problem happens out of hours and you are concerned about your child’s welfare, you may need to contact Sheffield Children’s hospital to get advice from the medical registrar on-call (contacted via switchboard 0114 271 7000).

Are there any problems associated with BiPAP use?

If your child’s mask is too tight on their face it can sometimes cause pressure areas on their face. This can cause discomfort and can make the face sore.

Make sure that the mask fit is good and not too tight. If your child’s face does become sore, please contact the team for advice.

If your child breathes out of time with the ventilator it will send the wrong pressure while breathing in or breathing out, which can cause discomfort.

The most common reason for this is a mask leak which can be fixed by using a different type of mask or by changing the settings on the machine. This can be done either at home or in hospital by the team.

How long will my child need to use bilevel ventilation for?

In most cases bilevel therapy is a long-term treatment. If your child follows the treatment, it will help their quality of sleep. This will then help:

• reduce tiredness in the daytime
• better school performance
• better quality of life for your child and family

Follow-up appointments

When you come for a follow-up appointment, please bring all of your child’s equipment with you. Including ventilator, mask and tubing so that we can check them.

Your child will have regular home visits from the specialist nurse to check on your progress and carry out home monitoring.

You will also have regular clinic appointments with your consultant in the hospital. Once a year your child will have an overnight stay in hospital to make sure all the settings on the machine are correct for your child’s needs.