Ideal ventilator settings for ALS and follow up

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Noninvasive
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Ideal ventilator settings for ALS and follow up

Postby Noninvasive » Thu Nov 24, 2016 4:13 pm

Two questions please. How do you decide whether your ventilator settings in ALS are satisfactory? What are target values for blood gases and for nocturnal oximetry/capnography. Is oxicapnonetry and blood gases enough to set the ventilator in ΑLS or do you require more advanced studies? Second, how often do you follow them and with what kinds of studies?

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michaelchiou
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Re: Ideal ventilator settings for ALS and follow up

Postby michaelchiou » Tue Nov 29, 2016 3:42 pm

Ventilator settings are satisfactory when the patient is comfortable and symptoms are relieved. Treat symptoms!

End-tidal CO2 should be less than 45 mmHg. Measuring blood gases is not necessary. Oximetry and capnography can provide information about O2 and CO2, respectively. Normally, oxygen saturations may dip at night (sometimes into the 80s or lower). They should not drop much further than that.

We follow these four ventilatory parameters for our patients at each visit: http://www.breathenvs.com/e-m-older-children-and-adults
Michael Chiou
Operations Director, VentilaMed BreatheNVS

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Re: Ideal ventilator settings for ALS and follow up

Postby Noninvasive » Wed Nov 30, 2016 1:54 pm

Thank you so much. And by the way: under which conditions do you consider end-tidal CO2 to be a reliable surrogate, e.g. normal A-a difference;

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Re: Ideal ventilator settings for ALS and follow up

Postby lousaporito » Wed Nov 30, 2016 3:32 pm

Noninvasive wrote:Thank you so much. And by the way: under which conditions do you consider end-tidal CO2 to be a reliable surrogate, e.g. normal A-a difference;


During normal spontaneous breathing, an un-impaired adult will have an EtCO2 that is 3-5 mmhg less than a concurrent arterial CO2 due airway dilution. The A-a gradient will widen as tidal breathing becomes more shallow. Measuring EtCO2 during NVS may be unreliable due to increased air dilution at the Nasal/oral interface. As long as SpO2 is in the 90's most of the time during sleep with NVS using room air and symptoms have improved, CO2 will remain at acceptable levels
Lou Saporito, BA, RRT
Technical Director, VentilaMed BreatheNVS
Technical Director, Center for Ventilator Management Alternatives

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Re: Ideal ventilator settings for ALS and follow up

Postby Noninvasive » Thu Dec 01, 2016 10:24 am

Thank you again.


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