Overview

Two Ventilating Strategies in One Mode

The Puritan Bennett™ BiLevel 2.0 software provides two strategies for enabling patients to breathe spontaneously at both upper and lower positive airway pressure levels, helping to improve synchrony.

  • APRV helps support the current goals for most ARDS patients while optimizing spontaneous breathing.
  • BiLevel ventilation in conventional TH:TL ratio simplifies the transition from controlled spontaneous breathing, without requiring any change of mode.

BiLevel ventilation has been shown to be associated with a reduction of opioid use by 40% in critically ill cancer patients under mechanical ventilator support.([FOOTNOTE=Saul J et al. The effect of Bi-Level ventilation on opioid utilization in a medical intensive care unit. Resp Care. 2000;45(8):1013.],[ANCHOR=],[LINK=])

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Features

Puritan Bennett™ BiLevel 2.0 software mode offers distinct enhancements over pressure support and pressure control, particularly in spontaneously breathing patients:

  • Synchronized transitions between Low Pressure (PL) and High Pressure (PH) levels with patient breathing([FOOTNOTE=Puritan Bennett™ 980 Series Ventilator Operator’s Manual.],[ANCHOR=],[LINK=])
  • Augmentation of all spontaneous breathing at high and low PEEP levels with at least 1.5 cmH2O of support
  • Monitoring of spirometry for all spontaneous breaths at PL and PH levels

Additionally, BiLevel mode offers expanded Pressure Support (PS) capabilities. When the time at lower PEEP is set long enough to allow spontaneous breathing, PS can be used. Breaths at the upper PH can also be assisted with Pressure Support.

Clinical Advantages

The clinical advantages of spontaneous breathing at two levels of pressure include:

A Decrease in Sedation

If the patient is allowed to breathe spontaneously during all phases of support, and transition between pressure levels is synchronized, sedation due to patient/ventilator dysynchrony may possibly be kept at a lower level.([FOOTNOTE=Lefebvre DL, Stock C. Airway pressure release ventilation. The Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.],[ANCHOR=],[LINK=]),([FOOTNOTE=Müller E. Clinical application of novel ventilation techniques. Int J Artif Organs. 1995;18(10):656-669.],[ANCHOR=],[LINK=]),([FOOTNOTE=Burchardi H, Rathgeber J, Sydow M. The concept of analgo-sedation depends on the concept of mechanical ventilation.Yearbook of Intensive Care and Emergency Medicine. 1995. Berlin.],[ANCHOR=],[LINK=]),([FOOTNOTE=Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA. Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation. Am J Respir Crit Care Med. 1994;149(6):1550-1556.],[ANCHOR=],[LINK=]),([FOOTNOTE=Stock MC. Conceptual basis for inverse ratio and airway pressure release ventilation. Seminars in Respiratory Medicine. July 1993;14(4):270-274.],[ANCHOR=],[LINK=])

Improved Patient Monitoring

BiLevel mode monitors mandatory and spontaneous tidal volumes and minute volume separately, which offers the clinician a clear understanding of how the patient’s spontaneous ventilation contributes to total ventilation.

Simplicity and Ease of Use

BiLevel 2.0 software combines two strategies in one mode. By allowing the principles of APRV to easily transition from controlled ventilation to all levels of augmented ventilation, BiLevel mode may be an appropriate tool for clinicians to manage a patient for the entire course of a patient’s disease process.4,([FOOTNOTE=Hörmann C, Baum M, Putensen C, Mutz NJ, Benzer H. Biphasic positive airway pressure (BIPAP)--a new mode of ventilatory support. Eur J Anaesthesiol. 1994;11(1):37-42.],[ANCHOR=],[LINK=])

Specifications

Resources