Ventilator settings

Please use this forum for any general discussions or questions you have about noninvasive ventilatory support and mechanical insufflation-exsufflation (MIE).
keaton85
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Ventilator settings

Postby keaton85 » Fri Apr 01, 2016 4:23 pm

Dr. Bach,

I think my email didn't make it clear that I actually have been using a trilogy 100 ventilator at night since my appointment at your office and I was using it when the o2 readings I sent you were captured. So why is o2 going down at night if I'm using it? Settings are fairly close to what you said except PEEP and rate. I'll change rate to 12 but PEEP can't be turned off unless circuit type is changed from passive to active. Is that safe to do? All settings below:

trilogy 100 ventilator
using full-face mask
mode ac
tidal volume 800 - can't set a range?
rate 10
flow pattern ramp
inspiratory time 1.4
peep 4.0cm h20
trigger auto-track

Looking at traveling to Rehabilitation Institute of Chicago but can't get there for a few weeks.

Garrett Anderson

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Re: Ventilator settings

Postby bachjr » Sat Apr 02, 2016 1:07 pm

Garrett,
Some people leak too much of the nasal ventilation out of the mouth during sleep. Before 1987 all people used a mouthpiece with lipseal retention during sleep. Since we described nasal ventilator support in 1987, most people have preferred nasal to lipseal but some awaken short of breath during sleep if too much air leaks out of the mouth. In this case they need to either switch to a lipseal or use a nasal prongs interface that also covers the mouth. Ask you home care company to bring you a Liberty or Hybrid oronasal interface and with leak eliminated your sleep O2 and CO2 will be better. Also, you are on BiPAP settings and that is never optimal. You should be using an active ventilator circuit with no EPAP/PEEP that blocks you from exhaling.
JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

keaton85
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Re: Ventilator settings

Postby keaton85 » Sun Apr 03, 2016 9:20 pm

Thank you. I will try that.

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Re: Ventilator settings

Postby keaton85 » Thu Apr 07, 2016 4:01 pm

Dr. Bach

Finally got to talk to my dme and they need an order from my doctor to change to an active ventilator circuit. I need to know what my pulmonologist should write on the script. I just want to clarify exactly what that is. I know I need a non-vented oronasal interface, but for the tubing Is it simply adding an exhale port to a standard vent tube like this

Image

or is it something more complex like this:
Image

without the trach adapter. Or do I have it all wrong?

Thanks.

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Re: Ventilator settings

Postby bachjr » Mon Apr 11, 2016 3:15 pm

You have it all right. Portable ventilator, Assist/control mode, volume 800 to 1400 ml as you find comfortable, nonvented interface nasal or oronasal, active circuit.
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

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Re: Ventilator settings

Postby bachjr » Mon Apr 11, 2016 3:16 pm

You have it all right. Portable ventilator, Assist/control mode, volume 800 to 1400 ml as you find comfortable, nonvented interface nasal or oronasal, active circuit.
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School

keaton85
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Re: Ventilator settings

Postby keaton85 » Mon Apr 11, 2016 5:41 pm

Thank you.

Garrett


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