saturation C02 level's drop while trying to use

[Indi's Gmomma]

This was the only thing I felt way different not being able to get last breath out before it forced or tried to send another breath in me then it didn't feel like it was working like it did before

Changes was made based on me telling them when I was in Hosp I felt like it was much stronger on my face, after I got leaks fixed, dr, I think randomly picked new #'s up to 18/10

We have tried both ways with oxygen and also told either way was fine, makes sense back of trilogy is best because it was made for this!

[Madalot]

I am still very concerned about the AVAPS settings.

My first Respiratory Therapist set me up and boy oh boy did she have it set up badly. I felt the machine was trying to kill me. She had my tidal volume set at 600 and would only drop it by 25 at a time. She also had the IPAP set to go as high as 30! I finally got my doctor to call me on a SUNDAY and she agreed to drop the Tidal Volume down to 400 and Max IPAP to 23. Luckily, I knew how to access the menu and do it myself because all this "send an order" then "order received" and "when can we come make the changes" and "Oh, it will be toward the end of the week" -- that nonsense is for the birds.

I made that change that day for Sunday night and it was an IMMEDIATE improvement.

I'm sharing my experience so you know that it is possible they don't have the settings optimized for your needs. It's very possible. And since I know they enabled AVAPS....

[robysue]

This was the only thing I felt way different not being able to get last breath out before it forced or tried to send another breath in me then it didn't feel like it was working like it did before

You absolutely HAVE to report this problem to your doctor. And report it as soon as possible---as in TODAY. I suspect that at a minimum, the respiratory rate (RR) is set way too high for you to be comfortable. And as madalot says, if the AVAPS settings are not properly tuned into YOUR needs, you're going to be fighting the machine as well.

Changes was made based on me telling them when I was in Hosp I felt like it was much stronger on my face, after I got leaks fixed, dr, I think randomly picked new #'s up to 18/10

Randomly picking numbers that are significantly different from the previous numbers is NOT a good way to fine tune your settings. You need to have a conversation with the doc about how and why s/he chose these particular settings. And you need to also inform the doc that the O2 levels still appear to be way too low.

[Guest]

Changes was made based on me telling them when I was in Hosp I felt like it was much stronger on my face, after I got leaks fixed, dr, I think randomly picked new #'s up to 18/10

Randomly picking numbers that are significantly different from the previous numbers is NOT a good way to fine tune your settings. You need to have a conversation with the doc about how and why s/he chose these particular settings. And you need to also inform the doc that the O2 levels still appear to be way too low.

He was concerned with what he had to go by, nothing basically just what I had been on in the past, but without a sleep study there was nothing else available.

[Indi's Gmomma]

I thought I was still signed on sorry above guest is me

[Indi's Gmomma]

Here are my settings:

AVAPS rate 1.0 cmh20
Dual prescription on
Tidlee volume 500
Ipap min 10
Ipap max 18
EPAP 8
Breath Rate 15
Inspatory Time 1.3
Trigger Type - Flow Trigger Auto Track
Flow Trigger Sensitivity 6.0
Flow Cycle Sensitivity 25%
Rise Time 4
Ramp 25 mins
Ramp start pressure 4.0 cmH20
All alarms are off

I called drs office but don't expect call back today its a clinic and they are not there every day, I may end up back at Hosp for changes

[Madalot]

Here are my settings:

AVAPS rate 1.0 cmh20
Dual prescription on
Tidlee volume 500
Ipap min 10
Ipap max 18
EPAP 8
Breath Rate 15
Inspatory Time 1.3
Trigger Type - Flow Trigger Auto Track
Flow Trigger Sensitivity 6.0
Flow Cycle Sensitivity 25%
Rise Time 4
Ramp 25 mins
Ramp start pressure 4.0 cmH20
All alarms are off

I called drs office but don't expect call back today its a clinic and they are not there every day, I may end up back at Hosp for changes

Remember, I'm not a doctor. Only speaking from my experience and from what I have learned here. The first thing that I saw was the Ramp being used and the starting pressure of 4. I don't know how anyone can breathe on the machine with the pressure that low.

I wonder if that could have a bearing on your issues? That and the Breath Rate (RR) being 15.

These are two things I find a little questionable.

[Indi's Gmomma]

I forgot to mention I don't use the ramp feature because your right I can't get a breath with it so I never hit ramp and if I do by mistake I just turn it off and back on

[JohnBFisher]

... RR = appears to be set to Auto; the back up respiratory rate determined on the fly by the machine based on the last several minutes of "normal" breathing. If your RR drops below that automatically determined RR, then the machine kicks in and switches from EPAP to IPAP in an attempt to trigger an inhalation. ...

I definitely concur. Most people use 10 or 12 breaths per minute (BPM) as their "floor". As frequently as 15 could "rush" your natural breathing. This would result in insufficient exchange of CO2 and O2.

But I also agree this is way beyond my pay grade. I just know when my machine pushes me to breathe too quickly I often feel as if I am not getting enough air. I get panicky and will stop my ASV therapy at that point. That resets the counters and lets me start from scratch.

Do keep us updated.

[Pugsy]

I definitely concur. Most people use 10 or 12 breaths per minute (BPM) as their "floor". As frequently as 15 could "rush" your natural breathing. This would result in insufficient exchange of CO2 and O2.

I have been thinking along the same lines here. While technically a rate of 15 shouldn't cause that hyperventilating thing and breathing instability...maybe for some people it can cause it due to other conditions involved.

[Indi's Gmomma]

The dr actually wrote RR15 on the orders so that's what the rt set it at, he's brand spanking new out if school so no telling why this didn't flag him as to high, and I started out clueless , but from the get go I've felt this was the culprit I've got another call into the ordering dr if I can just track him down, I saw him at a clinic and he's not there again today

[sftballslh]

I guess I'm not very well versed in all the lingo I'm new to all this I was only referring to my oxygen, thanks for the correction, I learn something new daily my problem is when I try to go to sleep my saturation level drops fast and we stop and I go back on my cannula at 2.5lp.

My dr just changed my setting and also told me to bump my 02 to 4 lpm when hooked up! Clearly something is wrong, my setting on my bipap were 12/8 and auto for something else but this trilogy the dr increased my presure setting to 18/10 and a rr15 I feal like I'm not getting my last breath out before my next one comes and it prevents the fresh 02 from making it to my lungs if this makes sense?[/quote]


You need your DME provider or whoever is in charge of your trilogy to come out and adjust your rise time, inspiratory time and trigger. Those are the settings that will adjust how long you have to inhale and how quickly it will change over from inhalation to exhalation.

[Indi's Gmomma]

You need your DME provider or whoever is in charge of your trilogy to come out and adjust your rise time, inspiratory time and trigger. Those are the settings that will adjust how long you have to inhale and how quickly it will change over from inhalation to exhalation.

Thanks for the help, do you know if my DME or RT can make these changes or if they need a Dr's prescription ? And I was under the impression these settings were all automatic? Was that overridden by the RR15 change ?

[Madalot]

You need your DME provider or whoever is in charge of your trilogy to come out and adjust your rise time, inspiratory time and trigger. Those are the settings that will adjust how long you have to inhale and how quickly it will change over from inhalation to exhalation.

Thanks for the help, do you know if my DME or RT can make these changes or if they need a Dr's prescription ? And I was under the impression these settings were all automatic? Was that overridden by the RR15 change ?

If your situation is like mine, TECHNICALLY, almost all changes require a doctor's prescription. Rise Time might be considered a patient comfort setting and available to you without access to the Clinician's Menu. I don't know because in my specific situation, I have been given FULL menu access and am allowed to make my own changes my all my settings (I have an arrangement with my doctor & DME to allow it with the understanding all THERAPY settings are discussed with my doctor before making the changes).

I personally feel that we don't know enough about the OP's condition or why the Trilogy was set the way it is. There may be "a method to their madness" at why they set it the way it did. However, I am concerned about the OP because she has shared that access to her medical team is a bit limited. I hate to think of her dealing with what I did -- having to wait days/weeks to get someone to help her make changes to the Trilogy so it CAN be better.

[jnk]

RT may need to ask doc if he/she was actually prescribing 15 RR as a backup rate or just noting daytime RR so that the RT could decide how to support it with RT-chosen settings. Some docs, especially hospital docs, expect RTs to take an active role in figuring out the Rx or figuring out how to support an Rx for vents in certain situations, as I understand it. Docs like being broad and idealistic. RTs figure out how to approximate the docs' ideals in the trenches of machine programming. Although I suffer from a lack of respect for many DME RTs, I have the utmost respect for the RT profession in relation to vent settings, and so do many docs.

Just as all friendships, marriages, and business partnerships are unique, the way a particular three-way team of doc/RT/patient works depends on a lot of factors. A neuromuscular patient making adjustments unilaterally on a vent can easily complicate that relationship beyond repair.

Be vocal but cooperative. Ask softly and calmly, but keep asking nonstop until you are confident your treatment is reasonably successful and reasonably comfortable, given your situation and overall health considerations. In doing so, try to differentiate between (1) the normal adjustment period of getting used to a particular machine and (2) dangerously out-of-parameter results for your situation. The first is irritating but natural. The second is not to be accepted under any circumstances but requires the gumption to relentlessly (though kindly) ask questions of the other members of your team until you are satisfied the present goals are being reached as safely and as comfortably as possible. Only your team (preferably including YOU) would know what those specific goals are in relation to your present circumstances.

In my opinion.