Life Can Be Better with BCV

Speak and eat, normally!

With ALS, a patient is already challenged with weakening muscles for speaking and eating, don’t add facemasks, intubation, or tracheostomy to prevent speech and nourishment even more!

Since BCV requires no facemask, a patient is not only free to eat and speak as normal, but the use of the cuirass actually exercises a patient’s own respiratory musculature generating a full range-of-motion.

Side-effects of other ventilation methods

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Face Mask Ventilators (PAP Devices)

Non-invasive face-mask ventilation has concerns and precautions which much be observed:

  • Claustrophobia can be a great concern for some patients whom cannot tolerate a face mask.
  • Claustrophobia involves the inability to begin or continually use mask ventilation.
  • Misshaped facial structure can make finding a mask that does not leak very difficult
  • Facial features such as a deviated septum can make breathing exclusively through the nose very difficult
  • Ventilation with a face mask may worsen sinus problems or cause severe abdominal distension (swelling of abdomen)
  • Facial weakness reduces necessary jaw closure and ability to use a mouthpiece
  • Patients may not comply with usage because of discomfort
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Even after using mask ventilation with success for some time, a patient’s breathing muscles can weaken more, due to lack of muscle usage and the fact that positive pressure in the airways creates a cardiopulmonary resistance which the system must now overcome in addition to room air pressure. This can further develop problems the patient is having with using their own respiratory effort.

Some examples of symptoms of muscle weakness can include:

  • Terrifying occurrences of suffocating or choking caused by mucus and a poor cough. Some manual assistance devices work well for some patients, but others find these methods minimally effective.
  • The usage required to use mask ventilation can increase from overnight to most of the day. Going out becomes more difficult because of assisting-equipment needs and the social stigma of wearing the face mask in public is unacceptable for some patients.
  • Pneumonia or a simple chest cold can result in a health crisis because of mask ventilation insufficiency. Many mask ventilation devices deliver air based on pressure sensing, so as the lungs become more closed, the pressure limit is reached more quickly and less air is delivered effectively.

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Intubation

BCV Sitting Use

If a patient requires ventilatory assistance which cannot be adequately helped with mask ventilation (PAP devices), typically physicians will move to invasive ventilation (endotracheal intubation). Due to the many well-known side effects of invasive mechanical ventilation, all options should be exhausted to prevent the patient from requiring this level of support.

If intubation is initiated, all efforts should be placed on removal of the endotracheal (ET) tube as quickly, while as safely, as possible. Many complications from intubation can arise, including but not limited to:

  • Aspiration – Entry of material (such as secretions, food or drink, or stomach contents) from the mouth or other areas, into the airways. Consequences of pulmonary aspiration range from no injury at all, to pneumonia, to death within minutes from suffocation.
  • Esophageal intubation – While performing intubation, sometimes the placement of the tube can incorrectly occur into the esophagus (to the stomach). This, obviously, leads to many problems, and may include death in some situations.
  • Injury – Placement of the tube can sometimes cause damage to the teeth, soft tissue at the back of the throat, or vocal cords, when done incorrectly.
  • Pneumothorax – Placement of the tube too deep can result in only one lung being ventilated and can result in a pneumothorax (collection of free air in the chest cavity that causes the lung to collapse) as well as inadequate ventilation.
  • Toxic effects of lung over-inflation (volutrauma) include pneumothorax and acute lung injury
  • Ventilator-associated pneumonia (VAP) risk develops the longer a patient is intubated, and can contribute to higher mortality rates.
  • Cardiac output may be decreased based on the preload- and afterload-reducing effects of positive pressure ventilation. Decreased cardiac output can have detrimental effects on patient health.

Intubation should be taken very seriously. A patient should fully understand the risks and complications involved in the placement of an endotracheal tube.

Before intubation, ensure that all other forms of ventilation have been attempted, including Biphasic Cuirass Ventilation (BCV), a non-invasive means of cardiopulmonary support, which has successfully been used to avoid intubation, or to wean off and facility the removal of an endotracheal tube.

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Tracheostomy

If determined that a patient will require ventilatory support long term while intubated, a trach may be considered, but all options to prevent the patient needing the tracheostomy have not been exhausted until ventilator weaning is attempted using BCV to assist the weaning process and as a means to meet the patient’s ongoing needs for support non-invasively. BCV use offers a greater likelihood that the ET tube can be successfully removed and a trach procedure prevented.

Tracheostomy placement can be a short term solution to a more comfortable and secure airway, but it can also be a life sentence for a patient to require this form of assistance, becoming dependent upon the trach.

Trach usage on an ongoing basis can have many risks, including:

  • Infections and complications from the procedure and wound site
  • Loss of voice over time
  • Psychological distress
  • Speech and language complications, especially in youth development
  • Higher risk of aspiration, along with impaired swallowing capabilities
  • Loss of smell and taste
  • Compromised nutritional health
  • Secretion issues
  • Loss of physiological PEEP and poor oxygenation

Hospital patients will receive a tracheostomy during an acute episode that lasts more that several days, stabilize, then be moved to another facility for vent weaning or rehab with their trach in place. The trach may ultimately be left in due to continued need to connect to the invasive vent. Trachs can be discontinued once the reason they were required is resolved. A care plan can be established with a goal of tracheal decannulation or trach removal. If the patient can be supported non-invasively, discontinuation of the trach can be considered.

Trach removal is usually a trial process in most cases. The tube has been in place usually for a significant length of time and the swallowing and airway tone maintenance reflexes and muscles of the upper airway may not be ready to resume full function and need to be conditioned with gradually increasing lengths of time with the trach plugged or capped.

Once fully established that the patient can tolerate the trach being capped most of the time, trach removal may be considered.

The ability of Biphasic Cuirass Ventilation to provide a non-invasive means of lung recruitment, airway clearance and non-mask support of spontaneous breathing using a patient’s own respiratory muscles makes it a valuable tool in the effort to advance the removal of a trach in a patient whom is trach-dependent.

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