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