Noninvasive vs invasive ventilation

Ventilation therapy, also called mechanical ventilation, helps you breathe by assisting the inhalation of oxygen and the exhalation of carbon dioxide through the lungs. Depending on your condition, ventilation therapy can help support or completely control your breathing.

The most common form is noninvasive ventilation therapy (often called “NIV”) where room air or oxygen is delivered by a ventilator through a full-face mask, nasal pillows mask, or mouthpiece. In early stages you may only use the ventilator at night, but as your disease progresses you may need to continue use during the day. Mouthpiece ventilation (MPV) is a form of noninvasive ventilation where a breath is delivered on-demand throughout the day with a mouthpiece. MPV is helpful if you have a neuromuscular disease or spinal cord injury and need breathing support due to weak breathing muscles.

Invasive ventilation (IV) is a more permanent means of delivering air to the lungs, common in late stage neuromuscular disease because of weakness of the mouth and throat muscles. This requires a major surgical procedure to create an opening through the neck into the trachea. A tube inserted into this opening provides the connection to the ventilator, provides an airway, and allows removal of secretions from the lungs.

After your doctor prescribes the necessary equipment, your respiratory therapist (RT) will visit you in the hospital before discharge to educate you and your care team on use, maintenance, and troubleshooting of your equipment. This training will be reinforced on your transfer to home. Your RT will also ensure your mask is suitable and comfortable for you to use.

Commonly prescribed equipment

Bi-Level Therapy

Bi-Level therapy is usually the first breathing support option if you are in an early stage disease. There are two primary types:

  • Spontaneous (S) devices respond when you inhale and exhale with no automatic delivery of breath.
  • Spontaneous/Timed (S/T) devices respond when you start to inhale and exhale and if you do not start inhaling within a set time the device automatically delivers a breath.

Mechanical Ventilation

Mechanical ventilators deliver a preset pressure and volume of air when you inhale. Ventilators can deliver higher volumes of air and pressure than bi-level machines, and also feature additional alarms and internal batteries. Ventilators like the Respironics Trilogy 100 are capable of completely taking over the breathing process, necessary for patients with neuromuscular disorders.

Secretion Management

Secretion management devices, such as the CoughAssist can supplement your ventilation therapy to increase the effectiveness of your cough and clear secretions from your lungs and trachea. This small electrical machine first delivers 
a large volume of air, then quickly reverses air flow to pull out secretions to help keep your airways clear and help reduce the chance of respiratory infection.

Humidification

A humidifier adds moisture to the air that is being delivered to you from your ventilator and can help alleviate most nasal problems. There are two types of humidification (heated and unheated). Heated humidifiers do not actually make the air hot, but instead increase the moisture content of the air that is delivered to you. Humidifiers can help to reduce some of the side effects of NIV therapy, such as dry nasal passages.

Additional equipment that may be provided with your ventilator includes additional external batteries and a ventilator stand which allows easy placement of the ventilator beside your bed. In certain cases, it may be possible for Medicare or your insurance to cover the cost of two ventilators if a second ventilator is necessary for your mobility, for example, if you need one kept beside your bed and another fixed to your wheelchair. Please ask your RT or contact our insurance intake team who will review your insurance and confer with your doctor for the appropriate documentation if this option is available to you.