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Positive Pressure

Some kids with chILD need more than just oxygen to help them breathe. The lungs might not be able to bring in enough oxygen or get rid of carbon dioxide. These children may need a machine that delivers air with pressure into their lungs. This is called positive pressure ventilation or positive pressure breathing.  

There are different types of positive pressure breathing. When the pressure is given through a mask or nose tube, it is called non-invasive. Some children need pressure to be given through a tube in the neck. This positive pressure is called invasive. 

CPAP and BiPAP machines can give breathing pressure using a face or nose mask. 

  • CPAP stands for Continuous Positive Airway Pressure.  With CPAP, the machine gives 1 pressure to the lungs all of the time. The amount of pressure can change based on what the child needs. Extra oxygen can also be given through the machine. 
  • BiPAP stands for BiLevel Positive Airway Pressure.  With BiPAP, the machine gives 2 different pressures. The pressure is higher when the child breathes in and lower when the child breathes out. The amount of pressure can change based on what the child needs. Extra oxygen can also be given through the machine. BiPAP machines can also have a rate to make sure the child is not breathing too slowly.  

Some children only use CPAP or BiPAP during sleep.  Other children may need CPAP or BiPAP for time during the day and night.  

Some kids with chILD need more help than just CPAP or BiPAP can give. The medical team may recommend a tracheostomy and ventilator.  

A tracheostomy is a short breathing tube.  It goes from the outside of the neck, through the skin and to the inside of the trachea (windpipe). The tube stays just below the voice box or vocal cords. A surgery is needed to place the tracheostomy. This is done by a pediatric surgeon or an ear, nose, and throat (ENT or otolaryngology) doctor. 

Tracheostomies can help if a child needs positive pressure for most of the day and night. Other kids may need a tracheostomy if they have blockage in their airway. 

If your child needs a tracheostomy, their care team will talk about the details of the surgery and how life will be different. This can be scary for families. But it may be the best way for your child to breathe.  

Click ​​here for more tracheostomy information from the American Thoracic Society. 

Ventilators are machines that give positive pressure to help children breathe. They can give just a little bit of help (like just CPAP or BiPAP). Or they can do all of the breathing for the child. Sometimes they are used for non-invasive pressure. Sometimes they are used for invasive pressure. 

Ventilators are used in the hospital but smaller machines can be used at home. Your child’s care team can help decide how much time they spend on the ventilator. Some children need the ventilator all of the time. Some children can come off of the ventilator as they grow older. 

A child on a ventilator can never be left alone. Your child’s medical team will help train you in how to take care of the ventilator. When possible, they can help with nursing support at home. You will have a durable medical equipment (DME) company to give you the supplies and help you when problems come up at home.  

Click ​​here for more information on ventilators from the American Thoracic Society. 

Author(s): Maria Santiago Teng  Reviewer(s): Katelyn Krivchenia  Version: 1.0


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