How to Navigate CPAP and BiPAP at Home by Lauren Perlman.
Hello, my name is Lauren Perlman.
I am a Respiratory Therapist at Boston Children's Hospital.
I will provide you with information on caring for your child who has been prescribed to
use BiPAP or CPAP therapy.
I will introduce you to some of the challenges and considerations regarding this therapy
on your child, such as the interfaces or masks they will need to use.
Will they get air in their stomach or have difficulty eating?
Will there be skin irritation from the mask and what can you do to avoid that?
Can you get help at home to help you keep this therapy going at home with your child?
Will there be alarms on the machines that are used to help deliver a CPAP or BiPAP therapy?
Might there be some considerations for the machine and/or the humidification system?
Do you need a humidification system?
And oxygen-- does your child use oxygen now?
Do they need oxygen during their therapy time?
What are CPAP and BiPAP?
Your child has been ordered for either CPAP, in which one positive pressure is applied
to their upper airway by a mask, or BiPAP therapy, in which there will be a baseline
positive pressure, the same is CPAP, and an inspiration pressure provided to their breaths
to increase the size of their breath or rest their muscles.
The child turns on all of their own breaths during CPAP.
During BiPAP therapy, your child also starts all of their own breaths, but there may be
a backup breath rate set for them and it will assist their breathing if they breathe below
the set rate.
A mask will cover your child's nose or nose and mouth.
There are also masks that cover the whole face, including the eyes, which are used if
the child's nose is sore due to skin irritation from the mask they are using.
Our preference is to cover the nose only, so the mouth is left uncovered.
This is important to reduce the chances of getting air in their stomach when they're
on the therapy, and also in case they have some difficulties with reflux or easily throwing
up.
Some children do need both their nose and mouth covered and there may be special considerations
for them, such as instructions to vent air from their feeding tube if they have one in
place when the mask is on.
Some children do not use the BiPAP just after eating.
Some children can use a nose mask with a chinstrap.
There are very few masks available for infants and young children due to their size.
Adolescence and teens can use the masks made for adults in size small or petite, and there
are many more options available for this group.
For young infants and toddlers, we have found the SleepNet MiniMe, Respironics Small Child,
ResMed Pixi, and Respironics Wisp Pediatric nasal masks helpful to fit this size range.
The Respironics Child Softcap Headgear may be used with some of these masks and is smaller
than what is provided with the mask.
Some of the adult nasal masks may be useful as a full-face mask for young infants and
toddlers, should they require their nose and mouth covered for their therapy.
Your child exhales carbon dioxide out of the masks through the holes in the mask.
Every mask should have vents or holes in it.
Please do check to be sure that you feel air constantly coming out of their mask when the
machine is turned on.
This does not include air coming out around the mask, where it is touching their skin.
For this leak of air, you will need to readjust the mask fit tightness.
Some of the hospital masks do not have these holes or vents in the mask, and they cannot
be used at home.
On occasion, if children are in the hospital and require a high percentage of oxygen, the
hospital uses non-vented masks and a different set up for the tubing in which there are two
pieces of hose-- one going from the machine to the child and one going from the mask away
from the child.
If you have any questions about this, please ask your provider to confirm that the mask
your child is leaving the hospital with is approved for home use with your child's machine.
If available to your child, having two different types of masks to use is important to try
to keep skin under the mask free of irritation.
There are many skin barrier products available and you should discuss this with your child's
caregivers.
The skin barrier product we recommend is Mepilex Lite.
This lightly adhesive product is cut to fit under the mask to protect the skin at the
contact points of the mask that are showing irritation.
The more hours your child uses a mask on their face, the more difficult it will be to manage
skin irritation, which is why we recommend having two different masks that may touch
the skin in different areas.
Children with CPAP and BiPAP therapy may qualify for funding for nursing care in the home.
As you are learning, it is difficult in some cases to keep the mask in place.
Please do speak with your child's case manager both at the hospital and from the insurance
providers.
There may be other needs that also will qualify your child for help in the home, such as a
feeding tube in place.
The CPAP and BiPAP machines do have alarms and they vary with each device.
Our recommendation is that children wearing a mask in which they cannot remove the mask
by themselves also wear an oxygen monitor or oximeter.
This can alarm for low oxygen levels and also heart rate changes.
Your child's heart rate may change when they are in distress, as well as their oxygen levels.
Please be aware that if the child moves the mask from their nose to their cheek, the machine
will not alarm for disconnect, but rather will provide CPAP or BiPAP therapy to their
cheek.
This is why the use of an oxygen and heart rate monitor is so important.
The oxygen monitor is difficult to use with very active children, as activity sets off
alarms that are not accurate.
Please do speak with your child's providers to discuss alarms for their safety when wearing
a mask over their nose, and particularly those wearing a mask over both nose and mouth.
Please do discuss whether your child requires a machine with a power failure alarm and/or
battery power in the event of a power failure at home.
Considerations for this decision are whether or not your child can take the mask off by
themselves, whether the mask is nasal only or does cover both nose and mouth, and most
importantly, does your child require this therapy when they're out of the home, such
as in the car and at school, in which a battery is needed to run the machine.
Something else to discuss with your providers is, can your child sleep without the BiPAP
or CPAP if the power fails?
Can they wait for the power to return?
Please ask your providers if your child should use humidification with their machine.
It is used in the hospital, but may not be necessary for home use.
Many people that use masks with CPAP and BiPAP complain that they don't like the hot air
in their face.
If your child has thick secretions that they cough out, they may benefit from the heat
of humidified air.
For some children, it tends to prevent nose bleeding from the dry air, but do remember
that they're breathing through their nose, just like you and me.
Oxygen may be added to the CPAP or BiPAP machine in liters per minute from your home oxygen
source.
You will adjust the oxygen litter flow based on the oxygen saturation monitor readings.
Please do ask your doctor to provide you with both high and low oxygen saturation levels
for your oxygen adjustments.
Your child's providers do understand how difficult it can be to keep a mask in place on young
children and those older adolescents with developmental delays.
Please do ask for suggestions with regard to your child, how to place the mask on and
keep it on for the prescribed time, such as overnight.
You should plan to spend at least one night with your child prior to going home in the
hospital, so that you can place their mask on the face and learn what to expect from
their machine.
Thank you for your time.
I do hope you found this instructional video helpful in managing your child's care with
CPAP and BiPAP.
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