Ask an expert: What makes Non-Invasive Ventilation so special?
We wanted to hear the perspective of a VitalAire respiratory therapists on the use of non-invasive ventilation at home. Susan Carlyle, Respiratory Therapist at VitalAire for 35 years and who has been involved in level 3 studies, CPAP and BiPAP therapy for 6 years, has agreed to answer our questions.
● Can you describe in few words what is NIV and the conditions NIV is used at home (vs in acute care)?
Non-Invasive therapy is used at home to support the patients breathing while sleeping at night in order to maintain good O2 levels and keep CO2 levels normal. NIV keeps them feeling well and out of hospital.The patients apply an interface just like they do for CPAP therapy. Actually, the BIPAP unit looks just like a CPAP/APAP machine. The CPAP/APAP will deliver a single pressure whether they are breathing in or out while a BIPAP machine will deliver 2 pressures: a higher one when breathing in and a lower one when breathing out.
● Which conditions do your NIV patients have?
NIV is generally prescribed for patients suffering of the following conditions: neuromuscular pathologies such as ALS, muscular dystrophy, multiple sclerosis; restrictive pathologies such as kyphoscoliosis (curvature of spine) or severe Obstructive Sleep Apnea (OSA) with hypoventilation.
● Is it difficult for patients to adhere to this kind of treatment?
Indeed, it is difficult for the patients as side effects like dry mouth can be quite disturbing. The patients need to be convinced and committed to adhere to their therapy. In some cases, they feel so much better or they realize they can’t breathe without the therapy. In other cases, they’re coping with pain, anxiety, insomnia and compliance is then difficult to achieve. The success of NIV therapy depends on the collaboration that exists between the patient, the respiratory therapist and the physician: the care team shall help them adapt to the treatment.
● Do you think NIV could be more widely used?
As the morbid obesity rates increase causing more OSA patients to move from CPAP to BIPAP or to start directly with BIPAP, the use of NIV should become more prevalent with the time. The use of NIV would benefit from a rising awareness of the different ventilation modes available in a BIPAP machine, as well as the benefits of the therapy when started sooner rather than later for other conditions than OSA.
● Can you tell us success stories of patients using NIV?
A young woman coping with multiple sclerosis, a diaphragm dysfunction and a recent ARDS was prescribed oxygen at 2-3 lpm. She is a wife and mother of 2 teenagers and a 4 year old. Since being discharged from hospital, activities of daily living are extremly difficult. Her global weakness was even present in her voice. She was admitted to a hospital-based intensive rehabilitation program where she was started on BIPAP therapy PC mode. On the first night she was able to sleep 8 hours on the BIPAP. She noticed a difference the next morning, as she felt more rested, and her voice was stronger.
A gentleman with COPD, obesity and hypoventilation, on oxygen 24/7 was started on BIPAP in July 2015. He was very angry and in denial and he couldn’t tolerate the pressure to the point where he returned his BIPAP. In December 2017, he decided to give it another try as he lost his driver’s license and wanted his independence back. We started him on a lower pressure this time and gradually increased it over a month. He is now using his BIPAP 7-8 hours per night and noticing he has more energy: he’s not as breathless as prior to the therapy and he has applied to get his driver’s license back.