Invasive Vs. Non-Invasive Ventilation: Advantages, risks, and complications - And my experience with both types of ventilation.

 Hi everyone! 

In this post, I'm going to discuss the two major types of mechanical life support. I will also discuss my experience with both types. I'm not a doctor or an expert by any means so don't base any decision off my post. This is simply my view.

When you have Duchenne Muscular Dystrophy, eventually your lungs are going to start being affected and you are going to need some sort of mechanical ventilation to help with breathing. There are two types of this, Invasive and Non-invasive(NIV). I have experienced using both and I will describe each.

Non-invasive ventilation(NIV)

With this type, the person uses a face mask strapped to their face usually over the nose which is connected to a ventilator. The ventilator pushes air into your lungs. Forms of noninvasive ventilation include machines you can use at home, like a CPAP(Continuous Positive Airway Pressure) machine or a BiPAP(Bi-level Positive Airway Pressure) machine. There are several advantages as well as risks and complications with this method which I will discuss.

Advantages-

• Easy to apply and remove masks.
• Improves patient comfort.
• Reduces need for sedation.
• Preserves speech, swallowing, and eating.
• Reduced cost of equipment and length of hospital stay.

Risks and Complications-
 

System

• Slower  correction of  gas exchange abnormalities
• Gastric distention

Mask

• Air leakage
• Eye irritation
• Damage to the facial skin(breakdown)

Lack of airway protection and access 

• Suctioning secretions
  Aspiration into lungs
   
• Possible Claustrophobia
• Increased work load and supervision

Invasive ventilation(Tracheostomy)

With this type, the person has a Tracheostomy tube surgically inserted through an incision in their neck and directly into the trachea providing an artificial airway. The tracheostomy tube is then usually connected to a portable ventilator. People with debilitating neuromuscular diseases such as myself as well as people who suffered a catastrophic spinal cord injury and are unable to breathe on their own may require Invasive Ventilation. In some cases the tracheostomy can be removed eventually. There are several advantages as well as risks and complications with this method which I will discuss. 

Advantages-

• Bypasses an upper airway obstruction
• Easier removal of secretions
• Permits long term mechanical ventilation
• Permits eating and probably makes it safer
• Permits speech
• Less risk of airway damage

Risks and Complications

During and shortly after procedure

• Bleeding 
• Air trapped around lungs(Pneumothorax)
• Damage to esophagus(rare)
• Injury to vocal cords(rare)
• Possible blood clots or mucus plugs

Later

• Decannulation or accidental removal of trach tube
• Infection in the trachea or around the stoma(the hole in the neck)
• Damage to windpipe
• Thinning of the trachea from the tube rubbing against it.
  

My experience-

I used Non-invasive ventilation from 2000 to 2018. I used a BiPap machine with a mask for 24 hours a day and I couldn't breathe without it. I benefited from the Advantages aside from the sedation part which I never required. However, I also suffered from most of the complications except for the claustrophobia. I rotated a couple different masks to alleviate the stress on my face. One of them I really liked but I couldn't wear it constantly because it would cut into the bridge of my nose and it would feel like my skin was coming off with the mask. The other one would sit right on the edge of my nostrils and after a while would irritate the inside of my nose. Plus it was cumbersome to put on. I continued putting up with it though because the idea of having a tracheostomy scared me. I t was a tube going through a hole in your neck into your trachea. It just seemed very daunting and it would be a big step it, it's usually a permanent change for people with DMD or spinal cord injuries. Despite my doctors insistence that I needed it to continue to live. They were trying to tell me it would improve my quality of life. I just wasn't having it.

Eventually, I didn't have a choice but to switch to Invasive Ventilation. When my respiratory system failed I had to be resuscitated and I almost died. After coming to, I was told that the NIV just wasn't ventilating me enough and hadn't been for years. I was given a couple choices.  I could just let nature take it's course because they weren't sending me home with the NIV the respiratory failure would almost certainly happen again. Or I could get a procedure known as a Tracheostomy where an incision is made in your throat about half way down your neck and they insert a tracheal tube into your trachea. I pretty much decided immediately to do it. After surviving all that it wouldn't be for nothing.

Living with a Trach-

At first, I didn't like it and I thought I made a mistake. I got the constant sensation that I couldn't breathe and I panicked a lot in the few weeks after getting it. After leaving the hospital and rehab, I noticed that I was much more comfortable on my Respironics Trilogy Ventilator. The vents in the hospitals seem to be much different from the ones you use at home. The one I was on in rehab I was breathing really fast so I felt like I wasn't getting enough oxygen it also seemed like the breaths were a lot shallower. A week after arriving home, my respiratory therapist Lauren and my Pulmonary doctor Dr. Cassavetes, came to visit for their routine check up. They actually make house calls from Boston to the Cape. I was an emotional wreck because I was still uncomfortable and thought I was going to be miserable for the rest of my life. I was crying and feeling depressed. Lauren looked at the machine settings and was like why the hell is it set like that? Meaning the rehab respiratory therapist had the completely wrong settings and that was why I was having a hard time. She made a couple adjustments and almost immediately I felt so much better I actually felt like I was breathing normally because I was.

From that day forward, I was so much more comfortable and happy. It was all looking up. I was able to speak again about two months after the surgery. I had no issues with it either it was like I never stopped. After 6 months I was able to begin eating and drinking again and just like the speaking, it was like I never stopped. Everything I was concerned about was proven wrong. I began living my life like normal again. We have to replace the trach tube monthly which is simple and quick. I also need to do a couple nebulizers a day and suction every once in a while but it’s not a big deal. I barely even notice it's there now and I just have normal days without worrying about my respiratory system. I can travel very well too and do we ever. We have to carry a little more equipment if we go out whether locally or long distances but its not a big deal. We went to Wyoming in June 2022 and we've been to North Carolina twice. We just got a new van too so here's to more long road trips.

Since I got the trach, I met some amazing people who are likely Angels in disguise. I met my wonderful nurse Christine Holman the day I came home and we had a lot of good times. In January of 2019, I met my favorite person to ever exist. A young woman named Kayla Sexton came to work as my aide. She is almost definitely an angel. Kayla and I got really close in the four years she worked her. I consider her my sister even though we aren't blood related. She is an amazing and wonderful person. She's so friendly and caring and loves to help everyone. She and her family are very dear to me. I also met several other great nurses because I chose life. Fern G., Kyla Mendes, Stephanie Murphy, Hannah McKnight, Denise Ried, Jennifer Mcneil, Connie Felker, Gail Borel, Susan Rourke, and Erin(I'm sorry I don't know your last name lol). I also made some good friends too. Jennifer Bedard, Krista Sexton(Kaylas sis), Aaliyah and Ryan(Kaylas daughter and son), Kyla Collette and Alex Tuckerman, and their children, Riley and Walker, and Christines husband Nate and her step kids, Max, Joey, Sam, and Ryan and Thuccy. I'm so glad you're all in my life and I'm so happy I chose to fight so I could meet you all. I think I'm going to end this here because its already a novel lol. 

Thank you so much for reading!