BiPAP to Trach


Chris (L) and Billy (R) sleeping after a long day at Legoland. Billy is hooked up to his BiPAP

I have been asked to write a little something about BiPAP to trach. My son Billy uses this set up and it has worked just fine for us. First let me explain a bit about what BiPAP is and does. Since I am not a professional medical person I will explain in layman's terms what it is. For all the medical mumbo jumbo like end-tidal CO2 pressure and EPAP and PIF, I suggest you talk to your Respiratory Therapist. :)

BiPAP stands for Bilevel Positive Airway Pressure and assists in breathing and helps keep the airway open and the lungs inflated. It differs from CPAP (Constant Positive Airway Pressure) in that it is not a constant pressure, rather it goes up and down with each breath. For example, Billy's rate is set on 10/4 (10 over 4). That means the pressure is 10 LPM (liters per minute) of air when he inhales and 4 LPM when he exhales. The idea is to give him a boost on the inhale so he has more air in the lungs and thus takes a deeper breath. He breathes very shallow at night. Billy does not have apnea.

For humidification, Billy's set up has a water chamber attached. He used to use an inline sponge filter, but that wasn't enough for him. The water chamber has worked well. The next step was to go to a heated water system, but that brings on another set of challenges. You must keep it very clean to keep from getting infections. I use sterile water in his water chamber. p> Billy is not on oxygen (O2), but O2 can be used with the BiPAP. Between the omni-flex adapter (a flexible elbow) that is attached to the trach and the hose (or circuit) that is attached to the water chamber, there is a plastic tube. They come in different types, but they all have holes or slots. Billy's has one bleed port (a hole) and then there is an adapter for an O2 hose. The hole must not become clogged or covered as that's where the CO2 (Carbon Dioxide) comes out. If the power goes out I have to disconnect Billy otherwise he could suffocate as there isn't enough pressure to dissipate the CO2 and it could build up.

BiPAP to trach is not FDA (Food & Drug Administration) approved because generally there are no alarms on the machines to warn of a pressure change or disconnect. I had to sign a waiver for our home health care company saying I understood this. However, BiPAP to trach is used safely in hospitals all the time. We were given the option of having a large ventilator instead to be used on the BiPAP setting, but I opted for the small, quiet machine. I had enough medical stuff in the house as it was! :) Billy sleeps in our room and we also have a monitor if we are in the family room so I can hear him just fine. I can tell the difference in pitch right away and will check on him. Even if I'm sound asleep I will wake up. :) Billy's machine does not have a timed back-up on it. What that is, is if the child doesn't take a breath within a certain time frame, the machine will kick in and give a breath. I supposed that would be appropriate for someone who has apnea.

BiPAP to trach has worked very nicely for Billy and I would recommend it to anyone. Of course you have to take into consideration your own comfort zone. There is no need to worry that your child will become dependant on the BiPAP either. That was a major concern for me as my sister is a Respiratory Therapist and she wasn't too positive about being vent dependant. Of course that is just her opinion, but I didn't want Billy to become dependant on a machine. He has a degenerative disease, as does his brother, so some day he might need a vent. But for now, the BiPAP makes his breathing easier and he doesn't have to work as hard and he gets a good nights sleep.