Congestive Heart Failure the Respiratory Perspective

Congestive Heart Failure

It is a fact that Congestive Heart Failure is an extremely frightening word and an equally frightening concept to comprehend, and when a loved one, or oneself has been diagnosed with this condition, it is quite natural to relapse into a state of depression or panic. However, it is not an untreatable disease, and with the correct and appropriate treatment methods, and with the right physician attending, the patient would be able to live a very productive life in the future, and look forward to living a long life too. This paper deals with 'what is Congestive Heart Failure', and how often does it occur. Who are the people who would be the most prone to this condition, and what can be done to prevent it. What are the various preventive measures that can be taken by other individuals who have been identified to belong to a high-risk group?

How can this condition be diagnosed accurately, and who diagnoses it? Is Congestive Heart Failure related to the respiratory tract in any way, and if so, how? Who is a 'Respiratory Therapist', and how can he help the patient who has been diagnosed as suffering from congestive heart failure and other problems of the respiratory tract? What is a Ventilation Machine, and how is it used for the treatment of the patient? What are the different types of ventilating machines, and how can they be used? How does the Respiratory Therapist handle the ventilator? How can the patient who is suffering from congestive heart failure be oxygenated, and how is it done? What about excessive fluid retention, how does it affect such patients, and what are the drugs that can be given to them so that excessive fluid is removed? And finally what is the quality of life that the patient of congestive heart failure can hope to live?

Introduction:

When a loved one is diagnosed with the frightening words 'Heart Failure' or 'Heart Disease', it can be an extremely traumatic experience for the individual. Statistics reveal that more than 5 million Americans have been diagnosed with heart failure and have been living their lives with ease for a great many years after the initial diagnosis was made, and this only shows that one is not alone with this diagnosis, and about 550,000 new cases are being diagnosed each and every single year. The important thing to remember is that this is an entirely manageable disease, and with the correct and appropriate and right treatment, it is very much possible to enjoy the best that life has to offer for a good many years. (Heart Failure: www.americanheart.org)

Analysis:

What, exactly, is Congestive Heart Failure? This is a condition in which the heart is not able to pump blood to all the organs within the body. This may happen due to a variety of reasons: one reason may be that the individual is suffering from coronary artery disease, and this means that the arteries that supply blood to the heart may have become too narrow, and this would obstruct the passage, and therefore, blood would not be able to flow with ease. Another reason for the occurrence of Congestive Heart Failure may be that the patient had already suffered from a heart attack, and/or may be suffering from myocardial infarction, that may have resulted in the formation of scar tissue, which would in turn obstruct the free flow of blood to the heart, and put a lot of strain on the heart muscle which would find it difficult to cope with the lessened blood flow. High blood pressure may also result in the formation of Congestive Heart Failure, as would any sort of heart valve disease that the patient may have suffered from earlier in his life. Heart valve disease may be caused due to past rheumatic fevers, and other illnesses. (Congestive Heart Failure: www.americanheart.org)

On the other hand, the heart muscle may in itself be affected with disease, and this is when it is referred to as 'cardiomyopathy'. Certain types of congenital heart defects and diseases may also cause Congestive Heart Failure, and the patient would have had the heart defect at birth itself. Another important reason for the occurrence of Congestive Heart Failure would be that of infection of the heart valve itself, and also the muscles of the heart, referred to as 'endocarditis', or 'myocarditis'. What would happen when a patient is suffering from Congestive Heart Failure is that the heart would continue to work, but not at all as efficiently as it should or would. The individual would feel tired and exhausted even after a small amount of exertion, and also out of breath after minor strains. This is because of the phenomenon of congestion in the tissues, which is caused by the slowing down of the flow of blood from the heart, due to which the blood that is supposed to flow back into the heart slows down because of the back up caused by the obstruction in the passage way, and this means that there will be swelling or what is known as 'edema'. (Congestive Heart Failure: www.americanheart.org)

Most often the swelling or edema occurs in the limbs, or in other words, in the legs and ankles, though it does occur in other parts of the body, like for example, in the lungs, and these results in the obstruction of the breathing process. When a person's lungs are congested, that person would find it difficult to even breathe, and would experience a shortness of breath and most often, when he lies down, would not be able to breathe. Sometimes, the kidney and its normal functioning gets affected by the phenomenon of Congestive Heart Failure, and this in turn interferes with the kidneys' ability to dispose of the sodium and water from within the body, and this would also contribute to the increase in the edema in the body.

How can Congestive Heart Failure be diagnosed? The best person to diagnose the disease would be the attending Physician or Doctor. The most frequent and common symptom of the disease is swollen ankles and legs, or edema or water retention, along with a certain difficulty in breathing. Another common symptom is that of weight gain, which is actually caused by the water retention within the body. After the Congestive Heart Failure has been diagnosed, the course of treatment is a combination of rest and a change and modification in diet and a general change in the patient's daily activities, with a treatment program with the appropriate drugs and medicines. Some of the drugs that the patient is advised to take are the following: beta-blockers, ACE, or 'angiotensin-converting enzymes' inhibitors. In addition, digitalis, diuretics, and vasodilators are also prescribed, and each drug performs a different function. (Congestive Heart Failure: www.americanheart.org)

The ACE Inhibitors and vasodilators have the function of expanding the narrowed blood vessels, and also decrease the resistance. The result is that the blood will be able to flow more easily, and also with considerably lesser amount of strain, and the heart can work easier. The beta-blockers have the function of improving the working of the pumping of the heart's lower left chamber, or what is known as the left ventricle. The pumping action of the heart would be improved to a certain extent by the digitalis, and the diuretics would help the body rid itself of the excess accumulated fluids and salts and water. However, if the physician is able to discover the specific cause of the Congestive Heart Failure, then that particular defect can be specifically treated, like for example, if the cause for the disease has been discovered to be an abnormal heart valve, then that abnormal valve can be surgically replaced or repaired, and if the cause is found to be because of high blood pressure, then the treatment for the blood pressure would in itself be sufficient for the treatment of the Congestive Heart Failure.

In some cases where the heart is found to be so very extremely damaged that it cannot be treated with drugs, then a heart transplant or the replacement of the damaged heart with a better one would be the only viable option left for the patient. However, the important fact to be remembered is that most patients who have been diagnosed with mild or moderate Congestive Heart Failure would be generally able to lead normal fulfilling lives, provided they are properly supervised medically with the appropriate drugs and other treatment options. This would prevent them from becoming invalids and dependent on others for their basic survival, and this in itself would be a great relief for the patient. (Congestive Heart Failure: www.americanheart.org)

Can Congestive Heart Failure be prevented, and what are the ways and means in which it can be prevented? The fact is that the diagnosis and the treatment and the various other forms of health care costs that are generally associated with Congestive Heart Failure are so very expensive, and the morbidity and the mortality are also so very high that most people would feel that it would be better if Congestive Heart Failure were to be prevented than if it were to be treated. If the various factors that exacerbate the condition were to be managed with the appropriate amount of aggression, like for example, if the symptoms of hypertension were to be managed well, then the Congestive Heart Failure would also be managed along with. In a similar manner, valvular disease and excessive intake of alcohol may have the result of ventricular dysfunction, and this would inevitably lead to heart failure if it were to be ignored or if the correct treatment method were to be ignored. (Cohn, 1998)

However, if the symptoms were to be managed well, then this would be sufficient enough to prevent the remodeling of the left ventricle, and the resulting dysfunction and the occurrence of Congestive Heart Failure. Similarly, early intervention with the appropriate treatment methods like the provision of angiotensin enzyme inhibitors would not only prevent the occurrence of Congestive Heart Failure but also treat the syndrome. Various other treatment or intervention methods for those patients who suffer from acute myocardial infarction would essentially slow down the process or even prevent the process of the remodeling of the left ventricle that generally precedes the development of the phenomenon of Congestive Heart Failure.

The primary care physician must be aware of the benefits of the early intervention procedures so that the patient as well as the society in general would be able to handle such patients in a better manner. It is a fact that Congestive Heart Failure usually occurs when there is cardiac disease present in the patient, and it is the dysfunction of the left ventricle that is the most obviously apparent symptom that occurs before the onset of Congestive Heart Failure. Therefore, when more efforts are undertaken to treat the etiologic factors in an appropriate manner, even before the starting of the progress of the Congestive Heart Failure, then that would be the best method of the prevention of the heart condition that is quite often fatal. (Cohn, 1998)

What is to be remembered is that though there is no known method in which to reverse heart damage and Congestive Heart Failure, the correct and right treatment can improve to significant levels the various signs and symptoms of heart disease, and it must also be remembered that if the patient were to make the appropriate changes in his lifestyle and in his diet, and were to take up specific exercises under the supervision of the attending physician, then the weakened heart would be able to function with more efficiency and also with considerably less effort. Since Congestive Heart Failure is not something that would occur all of a sudden to catch the patient completely unawares, if certain steps were to be taken, it could very well be prevented. Congestive Heart Failure generally develops gradually, over a certain period of time, and sometimes, the very first symptom may be a shortness of breath and also a difficulty in breathing. Therefore, when the patient of heart disease undertakes to make the necessary changes in his lifestyle and general habits, it may be considered to be the very first step in the prevention process of the Congestive Heart Failure that may occur due to certain unmanaged and uncontrolled symptoms exhibited by the patient, like for example, high blood pressure, which, were it to be treated at its early stage, would not lead to a weakening of the heart. (Congestive Heart Failure: Mayo Clinic)

When Congestive Heart Failure is related to the respiratory tract, then it must be considered as a serious and chronic health condition with a high rate of morbidity as well as mortality, and the great tragedy is that it can in fact be very effectively prevented with certain precautionary measures that the wary attending physician would be able to prescribe for the patient so that his heart condition would not lead, inevitably, to Congestive Heart Failure. The fact is that the traditional health-care systems that exist today have the point of focus the treatment of the disease at the final point of failure, like for example, a life saving surgery or an intensive and aggressive medical therapy, rather than attempting to prevent it at the very outset. The fact that the existing population is ageing, and that more and more people are hoping to live longer lives makes it more and more necessary to manage the health factor of life and the life threatening diseases such as Congestive Heart Failure in a much better and more efficient manner than is being done at present. It is an issue of major concern that the disease is not being given the prominence and the importance that it deserves, as a major and chronic health condition with the resultant loss in the very quality of life of the patient. (Population Monitoring of Quality of Life for Congestive Heart Failure)

When the disease manifests itself in the respiratory system of the body, then it is generally known as Congestive Heart Failure of the Respiratory Tract. This means that the heart has become extremely congested and is not bale to pump blood at its optimum best, and at the needed blood volume. If the lungs were congested, then the symptoms would be labored breathing and wheezing and auscultation of crackles as well as wheezes and an extreme shortness of breath. These symptoms may lead to the onset of the phenomenon of orthopnea, which n other words, means that the patient would experience extreme difficulty in lying down or maintaining a supine position for very long. This is actually caused by the venous return of the blood to the heart, and this would in turn lead to greater amounts of congestion on the heart. There may also be an onset of 'cardiac asthma', which is dyspnea accompanied by wheezing, a non-productive cough, and loud volume gurgling sounds made by the patient. (Almazan; McFarland; Sanders, Congestive Heart Failure)

All the above mentioned symptoms are suggestive of 'pulmonary edema', and when an episode of acute respiratory distress occurs, it is indicated by an extreme breathlessness, increased rate of respirations, an accessory use of muscle, a nasal flaring, a bulging of the neck muscles due to the strain that the patient is undergoing while trying to breathe, a very loud expiratory as well as inspiratory breathing, a profuse diaphoresis, and cold and ashen and cyanotic skin color. This color is indicative of the fact that the patient has a decreased cardiac output, and also an increase in the sympathetic nervous system stimulation that generally occurs as a result of the cardiac problem, and also a peripheral vasoconstriction, and a total desaturation of the arterial blood. When cardiovascular assessment is carried out, then the various reasons for the occurrence of the Congestive Heart Failure can be discovered. The very auscultation of the S. And S. sounds that the patient makes while attempting to breathe show that the heart is in fact starting to go into a failure mode, and this also means that there is an increase in the blood volume within the ventricle, with each and every beat that the heart makes. The heart beat rate can also increase dramatically, and this is generally taken as a compensatory response to try to increase the cardiac output of the patient that at present is not at its best level.

The severity of the heart failure can be effectively measured by the method of 'hemodynamic monitoring' with which can indicate the exact level of the extent of failure. The 'Capillary Wedge Pressure' indicates the left ventricular end diastolic pressure, and if the reading is above 8 to 10 MM Hg, then it can be taken as an indicator of a decrease in cardiac output, and of hypo tension, as well as tachycardia. If the figures indicate a reading of above 18 MM Hg, then it can be taken as an indicator of pulmonary congestion. If there were an increase in the central venous pressure, that is, a figure that is greater than 12 MM Hg, then it would indicate a failure of the right ventricle, while left ventricular failure is indicated by a decrease in cardiac output, which generally leads to hypo tension. The electrocardiogram will also reveal the extent of the cardiac output of the patient, and show all the areas, in which there has been a change or a difference in the function and the structure of the heart, and which indicate the dysrhythmias that the heart has gone through. (Almazan; McFarland; Sanders, Congestive Heart Failure)

Who is a 'Respiratory Therapist', and how can he help to improve the life of the patient who is suffering from the symptoms of Congestive Heart Failure? It is a fact that everyone in the world takes the act of breathing completely for granted, without even sparing a second to analyze the intricacies and the importance of taking a deep breath of air. This is because the act of breathing is instinctive and does not have to be taught or learnt, and it is second nature to every living being on earth. However, when an individual suffers from some sort of difficulty in breathing, that is when he realizes the importance of drawing breath, and it is when every breath that he is able to take becomes a major accomplishment that he would appreciate the value of good respiration and breathing. There are thousands upon thousands of people all over the world who suffer from some sort of breathing problem, either major or minor. These are the people, who suffer from either chronic lung problems, or from asthma or bronchitis, or from emphysema, and from Congestive Heart Failure. (What is a Respiratory Therapist?)

Other respiratory problems may occur in accident victims, heart attack victims, victims of lung cancer, and victims of AIDS, and people who suffer from cystic fibrosis and infants who have any type of respiratory defects. All these people will receive treatment from a 'Respiratory Therapist' under the supervision of a Doctor and Physician. The Respiratory Therapist works towards evaluating and analyzing, and treating those patients who have been diagnosed with respiratory disorders of any kind. The patients may belong to any age group, and to any social class, and may need any of several different types of health care and varying treatments. The Respiratory Therapist generally belongs to a certain health care team that works towards providing appropriate respiratory care for those patients who have been diagnosed with respiratory disorders of the lung as well a of the heart. The Respiratory Therapist works in a hospital where he works towards providing intensive care, critical care, and infant care for all their patients belonging to different age groups. (What is a Respiratory Therapist?)

These dedicated professionals are also expected to be a part of the lifesaving response team that generally responds to any emergencies any other type of situation that would need immediate critical care of the patient if he were expected to survive the crisis that he was at present undergoing. However, the Respiratory Therapist can also work from a home, or from a physician's office, or from a skilled nursing facility, and even at times from a specialized care hospital. The Respiratory Therapist is expected to perform a large number of activities as a part of his list of duties in looking after the patient with respiratory problems. These are the following activities that are related to the diagnosis of the disease that the patient seems to be suffering from: he would have to obtain sputum and breath specimens from the patient for the purpose of conducting analyses, he would also have to obtain blood specimens, and conduct various analyses that would determine the oxygen and carbon-dioxide and other gases' levels in the blood of the patient, and interpret all the data that is generated after testing the specimens. He must also be proficient enough to be able to test the lung capacity of the patient to analyze the presence of any sort of impairment in the functioning of the lungs.

In addition, the Respiratory Therapist would also be expected to perform and analyze the stress tests and the functioning tests of the cardiopulmonary system of the patient. He would also analyze the sleep patterns of those people who are suffering from disruptive sleep disorders, and come up with appropriate conclusions of the presented patterns after analysis. As a part of the treatment of the patient suffering from breathing and respiratory disorders, the Respiratory Therapist is responsible for the operation of and the maintenance of the various types of equipment that are needed for the administration of oxygen and for any other type of assistance in the breathing of the patient. He is also responsible for using mechanical means of ventilation for those patients who find it extremely difficult to breathe on their own. The Respiratory Therapist is also expected to be familiar with the various methods of monitoring the patient as well as to be proficient in managing the specific therapy that has been prescribed by the Doctor for the patient that would help him to recover complete or at least a part of his original lung functioning. (What is a Respiratory Therapist?)

The Respiratory Therapist must also learn the administration of medication in aerosol form so that the patient's breathing problems may be alleviated, and so that frequent respiratory infections may be effectively prevented. The response of the patient must be monitored so that if there is any discrepancy it may be changed at once, and the Respiratory Therapist must be well versed in monitoring equipment so that the patient would find it easier to breathe and be more independent. Sometimes, some patients who are suffering from chronic respiratory infections or diseases like bronchitis, congestive heart failure, and any impairment of the functioning of the lung are advised by the attending physician to take part in mild and low-impact aerobic exercise activities so that they may be rehabilitated into the mainstream of life at the earliest.

At these times, it is the responsibility of the Respiratory Therapist to supervise the exercise activities of the patient so that he does not strain himself to a larger extent than is necessary. The patient is sometimes fitted with a respiratory tube in severe cases when he cannot breathe on his own through normal means, and the Respiratory Therapist will supervise and monitor this piece of artificial breathing methodology and maintain the patient's artificial airway. Tobacco and smoking cessation classes will also be conducted by the Respiratory Therapist for those people who want to throw off the smoking habit forever, and theses people are helped to a great extent by attending such classes that educate them on the ill-effects of smoking and at the same time offer different ways and means in which to tackle this menace. (What is a Respiratory Therapist?)

How does a Respiratory Therapist help and improve the life of the patient through a ventilation machine, and what sort of ventilation machine is generally used in such forms of treatment? What, exactly, is a Ventilation Machine, and how does it help? At times, the patient who is suffering from any type of respiratory disorder, including that caused by congestive heart failure, has to be hospitalized for the treatment of his respiratory problem. In such cases, the patient is initially treated with a course of antibiotics and other drugs, which are sometimes administered intravenously. Oxygen levels in the blood would be monitored and measured, and the patient would have several chest X-rays taken, as well as blood tests. This battery of tests would help the health-care provider decide on the best course of treatment that would be the most effective for the patient.

If, however, the patient fails to respond to all the treatments being given to him to combat his illness, and he still finds it extremely difficult to breathe normally, and on his own, then it would be decided that he needs help to breathe. The patient would therefore be fitted with a 'nasal cannula' or a tube fit through the nose, through a loose fitting mask that is placed over the nose and the mouth of the patient, which would help him to breathe better. Sometimes, a tight fitting mask is also used as a part of non-invasive ventilation aids, and the patient can then draw breath with ease. At times, when it is discovered that even these methods do no work for the patient, then a tube is inserted down the patient's trachea, and this is where the Ventilation Machine steps in. The tube is connected to the Ventilation Machine, and this machine would virtually breathe for the patient. The tube may be of two types; one is an'endotracheal tube' that is inserted into the nose or into the mouth, and a 'tracheostomy tube', which is a tube inserted into the neck of the patient after an incision.

What does this machine do? It breathes for the patient by pushing air into his lungs, and then waiting for a few seconds for the lungs to empty and then pushing air in again. The Ventilation Machine is also known as a 'Respirator' and a 'Breathing machine'. The basic and essential function of the Ventilation Machine is that of delivering oxygen, getting rid of the carbon-dioxide within the lungs, and generally making the act of breathing more comfortable for the unfortunate patient. Most of the time, the Ventilation Machine is used as a temporary measure until the time when the patient recovers completely from his illness and is able to breathe on his own. However, in some cases, the patient will never ever be able to breathe on his own again, even after he has recovered fully from his illness. At these times, the family of the patient must be consulted and the decision must be taken as to how long he is to remain on the Ventilation Machine, and how long acute care must be provided for him, especially if it has been diagnosed that the patient has no more chances of recovery at all. When such patients are disconnected from the Ventilation Machine, they would not breathe and continue living. (What happens If I have to go to the Hospital Because I have difficulty Breathing?)

Life Support is another term that is given for the entire spectrum of techniques and methods that are used to maintain life after the failure of the vital organ or organs of the patient, for which the Ventilation Machine is an important component. The failure of vital organs may result due to a number of reasons, like for example, a heart attack, or cancer, or any sort of chronic disease with which the patient has been living for a number of years. The innate purpose of a life support system, that includes the Ventilation Machine, is that of establishing and maintaining the ABC's or in other words, the resuscitation-airway, the breathing, and the circulation of the patient. This helps to restore as well as to maintain the homeostasis of the patient, which in other words refers to the internal chemical and the physical balance of the body. The patient would therefore be totally and completely protected against all the underlying complications of the disease and also from the treatment for the disease. (Life support)

What is the type of Ventilation Machine or Ventilator that can be used for a patient who is suffering from Congestive Heart failure? It is a fact that it is over the past few decades that quite a few studies have been conducted on the efficacy and efficiency of the ventilator in treating a patient who is found to have the various symptoms of congestive heart failure. Further studies on the non-invasive ventilation method for treating the same patients have also been conducted and it has been found that most of these studies have had as their primary focus the fact that Non-invasive Ventilation has been used more as an effort to avoid endotracheal intubation and all the various complications that result from this method, rather than focusing on the several Congestive Heart Failure patients who would in fact enjoy the maximum benefit of a good non-invasive ventilation method. As a result, what has happened is that the clinical usage of the non-invasive ventilation method for the benefit of a severely affected Congestive Heart Failure patient has become an extremely controversial subject.

However, most of the studies support the use of this technique for those patients with acute cardiogenic pulmonary edema, and when it is used, the mortality rates are significantly reduced, and there is a lower rate of indotracheal intubation. The two important Non-invasive Ventilation modalities are that of 'continuous positive airway pressure', and 'bi-level positive airway pressure'. It has been found that the latter has more advantages than the former, but the safety factor of the former is considerably higher than that of the latter. The trick lies in the selection of the correct procedure for the correct patient, and then when the appropriate monitoring procedures are used, then the technology would prove its usefulness over and over again. Some of the earliest methods of Non-invasive Ventilation in acute care for those patients with Chronic and Congestive Heart Failure and other such diseases were the intermittent pressure breathing methodology, or in other words, the IPPB, that would allow the patient to breathe through a facemask or a mouthpiece. (Role of Non-invasive Ventilation in the management of acutely decompensated heart failure)

In the method, the ventilator would be pressure cycled, and it would be able to deliver a positive pressure flow of air to the patient, provided the patient was able to put in his own inspirational efforts. This method was most often utilized to deliver bronchodilator treatment for those patients who had any type of respiratory disorders, especially the type of disorder that is associated with chronic heart failure and with asthma and obstructive pulmonary disease. The IPPB pressure was found to be able to drive the aerosol particles very deep into the distal airways of the patient, because of which the patient could not only breathe easier but also had an overall positive impact on the entire respiratory system. When the other Non-invasive Ventilation method which is that of Continuous Positive Airway Pressure or in other words- CPAP, was found that this method provided a continuous background of positive pressure for the patient, because of which he would be able to breathe easier. The working principle was very simple: what it did was to maintain a steady pressure, below which the pressure in the airway of the patient was not allowed to drop down.

This in other words means that the very same pressure is exerted both while the patient is inspiring as well as stopping his breath. This leads to the obvious conclusion that the method would allow better oxygenation in the airway of the patient because of the fact that it would automatically increase the functional residual capacity as well as the lung capacity of the patient. The best part is that this is a totally Non-invasive Ventilation method, and it can be applied with the use of a simple facemask or a nasal mask. The negative factor that exists in both the IPPB and in the CPAP ventilation methods is that there is a fear that venous return of blood may decrease, and this in turn would lead to more of a strain on the heart, and therefore, a decrease in cardiac output. At the same time, there is evidence to support the fact that the CPAP method is able to supply some part of the inflating pressure that is needed for inspiration, and this would, in fact, lessen the fatigue of the muscles, and off-load them. (Role of Non-invasive Ventilation in the management of acutely decompensated heart failure)

Another later and newer Non-Invasive Ventilation method that has only recently been developed is that of the Bi-level Positive Airway Pressure; which is a combination of the IPPB and the CPAP methods. In this method, higher airway pressures are applied during inspiration, and lesser pressures exerted during expiration, and this automatically means that higher positive inspiratory support would be applied for longer amounts of time for the patient with respiratory and breathing difficulties. The procedure can be applied nasally, and also with facemasks. When it is applied nasally, the mask used for the purpose would be much smaller and configured, and this would offer greater amounts of comfort and ease for the patient. In addition, any sort of airway secretions can also be cleared away effectively by the use of the small nasal masks, and the patient would find this very comfortable indeed.

When the CPAP method is used, it must be remembered that the patient must cooperate well with the helpers and technicians and the Respiratory Therapist to make sure that it is in place and working well at all times, and also to ensure that there is no significant leakage of oxygen from the mask at any time. With the Bi-level Positive Airway Pressure, or the BLPAP, however, there will be no significant air leaks, and this also means that the patient need not be very cooperative with the staff of the hospital. However, it is a fact that with all the non-invasive ventilatory procedures that exist, it is the patient who controls the breathing frequency as well as the tidal volume of the oxygen being given to him through the masks, and most of the newer modalities of the BLPAP method have highly sensitive and flow-triggered inspiratory valves that serve to not only reduce the effort that the patient has to make in order to draw breath, but also significantly reduce the time that the patient has to take from the initiation of his breath until the time when he can actually make use of the assistance that is being offered to him in the form of the ventilator. (Role of Non-invasive Ventilation in the management of acutely decompensated heart failure)

There are several advantages as well as disadvantages in the use of the Non-Invasive Ventilation that is used for those patients who are faced with respiratory problems after an attack of any kind, including asthma and bronchitis and congestive heart failure. Some of the major advantages are that it allows the patient to put in lesser effort into the breathing process, and also increases functional residual capacity. In addition, the method also improves the general pulmonary function of the patient, as well as improves the exchange of gases that takes place within the body. It reduces the venous return to the heart, which in some cases of hypotension, would turn into a major disadvantage. Since it is well-known that the costs of intubation and all its associated costs are generally astronomical and unaffordable by the average patient with respiratory difficulties, the advantage of this non-invasive method lies in the fact that these costs do not exist. (Role of Non-invasive Ventilation in the management of acutely decompensated heart failure)