Bi-Level Ventilation

What is Bi-Level Ventilation?

Bi-Level therapy (or BiPAP) is a type of breathing support that assists your child's ability to breath. It involves the use of a mask and a Bi-Level device. The Bi-Level device delivers pressure via the mask to the airway and lungs. This opens the airways to allow normal breathing to occur. Normal breathing is important as it helps deliver oxygen and get rid of carbon dioxide. The pressure in Bi-Level therapy is delivered at 2 levels - inspiratory (breathing in) pressure and expiratory (breathing out) pressure.

Why does your child need Bi-Level Ventilation?

Your doctor has told you that your child has a breathing disorder called Central Sleep apnea (CSA) or hypoventilation. In CSA the body "forgets" to breathe for periods when asleep. Hypoventilation happens when your child does not breathe enough.

CSA and hypoventilation are only a problem when your child sleeps. For this reason your child will be required to use Bi-Level when sleeping. Bi-Level provides pressure throughout the night to prevent the airways closing. It also helps your child's breathing rate.

If your child sleeps during the day it is important to also use Bi-Level for these naps.

What will we do?

Once it has been decided that your child needs Bi-Level you will meet with the Clinical Nurse Consultant (CNC) or the Scientific Officer. During this appointment your child will be fitted with a mask. Your child needs to get use to wearing the mask before Bi-Level therapy can start. You will take the mask home and over the next few days encourage your child to wear the mask for short periods. This can be when your child is either awake or asleep, as the objective is to ensure that your child is not fearful of the mask. Once your child is happy wearing the mask, call the Scientific Officer and we can book them in for admission to hospital to commence Bi-Level. Your child will generally be in hospital for 5-7 nights while we alter the pressures and they get used to using Bi-Level. During this time you will get education and information about the Bi-Level device so you can use the machine when you go home. You will be also be given contact details in case there is a problem with the Bi-Level device that you can't fix.

How do you get the mask and machine?

The Children's Hospital has a limited supply of Bi-Level devices. For this reason you will be required to rent or purchase the device from a company. These companies include: Air Liquide, ResMed, Mayo Health Care (Sleepezy) and CPAP Australia. Some families may qualify for funding through a funding scheme. Please advise us if you have a health care card, so we can assist any application for purchase or funding.

Your child will use the hospital's mask when they go home. For long term use of more than 3 months you will be required to purchase a mask for your child. The hospital's mask is then to be returned. Masks cost $180 to $260.

How long will your child need to use Bi-Level Ventilation?

In most cases Bi-Level therapy is a long term treatment. For this reason it is important to have regular follow-up appointments with your Sleep/Respiratory Doctor. Your child will also need to have regular sleep studies to monitor their progress.

What if your child becomes unwell at home?

If your child gets sick and needs to come to the Emergency Department you will need to bring all Bi-Level equipment with you.

If your child is breathing rapidly, noisily or seems to be having difficulty breathing you should see a doctor urgently.

If the problem is very severe you may see a dusky colour around your child's lips or there may be pauses when they stop breathing. You should call an ambulance if this occurs.

• Your child will need to use Bi-Level every time they sleep.
• Your child will need to get use to wearing the mask at home before we commence Bi-Level in hospital.
• You will be required to rent or purchase the Bi-Level machine from a company. You will be required to purchase a Bi-Level mask for long term use.
• Children using Bi-Level will need regular assessment and follow up.

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