Why BIPAP

[Mikesus]

Conditions Frequently Treated with Bilevel Devices &/or NPPV
Now, physicians typically use bilevel therapy to treat a broad range of conditions, including some conditions that require 24-hour ventilatory support.
o Respiratory muscle dysfunction (CO2 >45 mm Hg)
o previous poliomyelitis
o muscular dystrophies
o myopathies
o Neurological disorders (CO2 >45 mm Hg)
o neuropathies
o bilateral diaphragmatic paralysis
o spinal cord injury
o brainstem lesions
o primary alveolar hypoventilation
o Chest wall deformity (CO2 >45 mm Hg)
o scoliosis
o thoracoplasty
o Upper airway disorders
o severe OSA
o obesity hypoventilation
o Lung disease (CO2 >52 mm Hg)
o COPD
o cystic fibrosis
o bronchiectasis
o Acute respiratory failure (CO2 >52 mm Hg)
o hypercapnic respiratory failure
o hypoxemic respiratory failure

Bilevel therapy is not typically prescribed for OSA patients; however, OSA patients who require high treatment pressures, OSA patients that can not tolerate exhaling against the set pressure of CPAP or OSA patients that have another respiratory condition like underlying lung disease (COPD) may be candidates for bilevel therapy.

Link here

[Guest]

I have been researching bi-level therapy and ran across this interesting post by Mikesus, so am bumping it to the top.

[rested gal]

Thanks, Guest. Good find and good bump-up. There are tons of excellent posts by Mikesus. He was (still is!) a great finder of articles and studies. One of my favorites that he first unearthed and posted was this one:

Not Every Patient Needs to Go to the Sleep Lab Powerpoint presentation by a well respected board certified sleep doctor/pulmonologist, Dr. Barbara Phillips, at a meeting of the American Lung Association of the Central Coast - November 2004

[Guest]

You're right, Rested Gal. That is an excellent presentation. Thanks for the link.

[dsm]

I will add my 0.2c worth in that to me, an *obvious* reason why BiLevels were usually prescribed to special medical conditions is *not* because of how they work but how much they cost.

I would like to see an *objective* medical assesment of the value of BiLevel therapy for OSA that takes into account the lowered cost of these machines as the technology advances.

It seems to me that when we see more and more BiLevel functionality being added to CPAP machines (such as is now in the Resmed S8 EPR machines) then the facts spell out where the therapy innovation is heading and the intrinsic value of improving the exhalation issues.

Exhalation against pressure is clearly the source of most problems users of xPAP experience. I would have thought this to be clearly self evident.

I am willing to posit that had BiLevels been as cheap to produce as CPAPs from the start, we would never have seen CPAP machines with constant pressure for IPAP EPAP. *Never*.

Cheers

DSM