By Dave Lynes
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Extra resources for The management of COPD in primary and secondary care : an introduction
However, although she sustained a fracture to her spine during the accident, her spinal cord was not initially damaged. The complexity of removing her from the vehicle resulted in the fracture becoming displaced and injuring her spinal cord. At this point, there were paramedics available to provide assisted ventilation, so she survived, but cannot now breathe on her own. Although breathing happens automatically, we can deliberately affect our breathing, for example by taking a deep breath. This voluntary control of breathing is organised by a part of the frontal lobe of the brain, and bypasses the respiratory centre in the brainstem in order to send messages (impulses) directly to respiratory neurones in the spinal cord (Saladin and Miller 2004).
Bilevel Positive Airways Pressure (BiPAP) BiPAP (Bilevel Positive Airways Pressure) (Jaarsma et al. 2001) is a bit like a combination of CPAP and Pressure Support. It does the same job as CPAP, from the point of view of providing a constant pressure within the airways, so that they are held open and the alveoli are kept slightly inflated (or slightly more inflated than usual), but it also tops each breath up so that reasonably good alveolar expansion is achieved, as happens in pressure support.
However, as babies survive earlier and earlier premature birth, it becomes harder to supply assisted ventilation 26 Why children need long-term respiratory support without any damage being caused to their alveoli. Premature babies like James often need to be given additional oxygen as well as receiving assisted ventilation. Although we all need to take in enough oxygen, getting too much of it can damage body tissue. The body has natural antioxidant systems to protect it from being damaged by excess oxygen, but these are not fully developed in premature babies (Philip 2009).