Search found 135 matches

by bachjr
Sun Aug 27, 2017 8:43 pm
Forum: Spinal Muscular Atrophy (SMA)
Topic: Bipap st
Replies: 2
Views: 738

Re: Bipap st

If she is standing, maybe she does not have paradoxical breathing and doesn't need BiPAP and that is why she is rejecting it. Generally the span of 18 or 22/4 is OK but 18/0 is more comfortable and better but you can not do that with BiPAP. Anyway, while she may not need BiPAP, her cough is certain...
by bachjr
Mon May 15, 2017 4:32 pm
Forum: General Discussion About Noninvasive Ventilatory Support (NVS)
Topic: Trilogy 100 setting trouble
Replies: 2
Views: 812

Re: Trilogy 100 setting trouble

Those settings are next to totally useless and unnecessarily uncomfortable. Go to a center where physicians understand NVS. See the list on http://www.breatheNVS.com
by bachjr
Mon May 15, 2017 4:31 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: More and more mucus (DMD)
Replies: 3
Views: 1110

Re: More and more mucus (DMD)

Some people's lips are too weak for mouth piece ventilation and need to use nasal prongs for daytime support. Difficulties with mucus are caused by dysphagia (swallowing problems), reflux, and allergies. Go to a center for noninvasive management on http://www.breatheNVS.com for assistance.
by bachjr
Mon May 15, 2017 4:29 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: DMD patient using sip technology
Replies: 5
Views: 1160

Re: DMD patient using sip technology

It sounds like the machine's sensitivity is too low. It should be no problem to get a deep breath from a mouth piece. Also, there should be no "PEEP" or "EPAP".
by bachjr
Mon May 15, 2017 4:27 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: Dornase alfa in DMD
Replies: 1
Views: 567

Re: Dornase alfa in DMD

No. In fact, nebulizing it is only likely to increase the secretions further. Positioning is the better strategy.
by bachjr
Mon May 15, 2017 4:26 pm
Forum: Spinal Muscular Atrophy (SMA)
Topic: Proactive use of BiPAP for Type 2 SMA
Replies: 1
Views: 712

Re: Proactive use of BiPAP for Type 2 SMA

If your child has paradoxical breathing, the chest sinks in when the belly goes out, then he needs nasal ventilation during sleep (not BiPAP) to reverse this otherwise his lungs will not grow. The "sleep studies" being done are useless. Also, no one "becomes dependent on BiPAP" ...
by bachjr
Wed Jan 25, 2017 1:47 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: More and more mucus (DMD)
Replies: 3
Views: 1110

Re: More and more mucus (DMD)

I seem to produce more mucus than I ever use to. What do you think could be causing this? Difficulty swallowing saliva causes this. Do you have any suggestions? Use a 15 mm angled mouthpiece for daytime ventilation rather than a nose piece. My mom talked with Louie and he suggested I try mouthpiece...
by bachjr
Sun Nov 13, 2016 2:37 pm
Forum: Amyotrophic Lateral Sclerosis (ALS)
Topic: Recommended initial Trilogy settings for the ALS patient
Replies: 3
Views: 875

Re: Recommended initial Trilogy settings for the ALS patient

I am a neurologist/sleep physician. I have been involved for the last year or 2 with a multidisciplinary ALS clinic, and was looking for some advice on how to start a patient on a trilogy, and any adjustments you may make over time to the settings. Until recently, we were using straight BIPAP, and ...
by bachjr
Sun Nov 13, 2016 2:29 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: DMD patient using sip technology
Replies: 5
Views: 1160

Re: DMD patient using sip technology

I think it might well be that nasal leakage and mouth seal are an issue although a nose clip didn’t seem to help. The problem with the ‘tongue touch’ is that after the touch he then struggles to coordinate an inspiration, presumably the leakage from lips and nose contribute to this. I will try him ...
by bachjr
Sun Nov 13, 2016 2:28 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: DMD patient using sip technology
Replies: 5
Views: 1160

Re: DMD patient using sip technology

I am keen to provide mouthpiece ventilation (MPV) for a DMD patient. I have tried and failed to get him using the ‘sip’ technology provided by Phillips simply because the patient cannot coordinate the ‘sip’ followed by an inspiration. I imagine that you have significant experience of using MPV, in ...
by bachjr
Sun Nov 13, 2016 2:22 pm
Forum: Spinal Cord Injury
Topic: C6 injury EXTUBATED!!
Replies: 2
Views: 1083

Re: C6 injury EXTUBATED!!

Our patient still has a c6 level. After about 2 weeks of ventilation on 21% O2 with cough assist and high PS I extubated her today. She did very well during the day on mouthpiece ventilation and required only occasional MIE. We will put her on mask ventilation for the night. I put her on PS 20 equi...
by bachjr
Sun Nov 13, 2016 2:13 pm
Forum: Nemaline Myopathy
Topic: 7.5 month old Nemaline myopathy - failure of NVS?
Replies: 1
Views: 923

Re: 7.5 month old Nemaline myopathy - failure of NVS?

We wanted to ask you for your advice about our son's situation. He is 7.5 months old and has Nemaline myopathy (neb-related). He is now in the PICU because in the last 2 weeks, he was struggling with saturation drops while being asleep into the 80s, sometimes lower, and it took some minutes to reco...
by bachjr
Sun Nov 13, 2016 10:29 am
Forum: General Discussion About Noninvasive Ventilatory Support (NVS)
Topic: Swallowing air while using the Trilogy Ventilator
Replies: 2
Views: 721

Re: Swallowing air while using the Trilogy Ventilator

Yes, that is common, but if severe then we need to have you switched to pressure preset ventilation. The advantage of volume preset is that you can take a volume and hold it and repeat the process (air stack) until you have a deep volume to speak loud, cough, and keep your lungs healthy. On volume,...
by bachjr
Fri Nov 11, 2016 8:34 am
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: pneumothorax
Replies: 8
Views: 1345

Re: pneumothorax

Michelle, as I told you the settings are not the problem. He takes as much of the air as he feels that he needs and no more. The problem is the weight. The more he weighs the more pressure is necessary to ventilate the lungs. That is what you should be worried about.
by bachjr
Thu Nov 10, 2016 8:33 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: pneumothorax
Replies: 8
Views: 1345

Re: pneumothorax

Michelle, I told you when you were here on Wednesday that no pressure at all can result in a pneumothorax. I think that you forgot.
by bachjr
Thu Nov 10, 2016 4:01 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: pneumothorax
Replies: 8
Views: 1345

Re: pneumothorax

Michelle, you can always find something to worry about but these settings are necessary for John. Anytime you want to reduce them, go away but when John complains, he will be right. JB
by bachjr
Thu Nov 10, 2016 2:26 pm
Forum: Duchenne Muscular Dystrophy (DMD)
Topic: pneumothorax
Replies: 8
Views: 1345

Re: pneumothorax

It is that high so that he can take all or part of the volume to vary his tidal volumes. Normally he should be able to take a breath to 3500 ml. The same settings can be good day and night because his brain can controls the air he gets whether awake or asleep. but he uses pressure preset during sle...
by bachjr
Fri Oct 07, 2016 7:41 am
Forum: General Discussion About Noninvasive Ventilatory Support (NVS)
Topic: Dr. Bach desperate need for recomendation of best ventilator for me
Replies: 14
Views: 2484

Re: Dr. Bach desperate need for recomendation of best ventilator for me

The Newport is fine but needs to be set up correctly so that none of the alarms sound, active circuit, volume preset ventilation 750 to 1400 ml, rate 10-12, nonvented nasal interfaces or interface holes covered.
by bachjr
Fri Oct 07, 2016 7:33 am
Forum: General Discussion About Noninvasive Ventilatory Support (NVS)
Topic: Dr. Bach desperate need for recomendation of best ventilator for me
Replies: 14
Views: 2484

Re: Dr. Bach desperate need for recomendation of best ventilator for me

PS I would be happy to explain it to them but they should read by extubation to NVS articles in Chest and Respiratory Care first.

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