LTV950 Ventilator and Mask

Does anyone use an LTV950 Ventilator non-invasively with a mask? My 19 year old daughter has respiratory distress and CO2 retention and must use this method at night. She previously used a BiPap machine, but the drs. found it was not as effective as the vent to keep her CO2 levels down. We experience the same leaks, skin irritations, etc. as the CPAP users. She currently uses a Mirage Full Face Liberty Mask that also has nasal pillows. The pillows pop out of her nostrils each night, causing whooshing noise, leaks, and O2 de-sats. We've adjusted the harness, tried popping the pillows back in, etc., but most nights it's still a problem. We tried the Comfort Gel Full Face Mask, but that also tends to leak around the eye area, causing skin breakdown and sores. She also got a large red bump on the bridge of her nose with that mask. We also tried her on a nasal only mask, but the extreme high pressure of her vent going through her nose freaked her out and was way too strong! Anyone out there using this method of ventilation?

I hadn't heard of that product before and had to look it up.

http://www.viasyshealthcare.com/prod_se ... prodID=108

It sounds like the masks have been too tight to cause those facial sores and skin problems.
Could you please tell us more about her situation? What pressure does she have?
We do have a few clinical-type people including nurses who hang out on the forum that may know more about that equipment and may be of more help. I'm just thinking that we might need some more information about her therapy.

Den

She went into respiratory failure due to weak muscles. We did NOT know she was retaining CO2, nor did we know her muscles were weak. All the doctors missed it. She was getting sicker, and sicker, and nobody saw it coming. Hard to believe, but true. She ended up in the hospital, intubated. She came off the intubation, but has been on nightime ventilation ever since, and for a few hours during the day. We have no diagnosis, no answers and we are working hard to keep her healthy. She's a wonderful, inspirational young adult. Her pressures on the vent are high; tidal volume of 700, pressure support of 17, breath rate of 17. In response to your reply about her facial sores, etc., the ulcers around the skin under her eye were due to leakage of air, and the sore on the bridge of her nose was definitely due to rubbing from the mask. It's so hard to fit the mask snuggly for no leaks, and not too snuggly so as to cause skin problems. I am sure everyone experiences these frustrations. If anyone online has any experiences with this type of ventilator/mask system, I would love to hear from you, or anyone else with an interest in this post. Thanks very much.

The mask leaks and pressure sores are definitely frustrating for many. I have been fortunate that I haven't had to deal much with mask leaks. All I can say is that every mask is different and every face is different. Keep trying masks until you find the right one for her face. Also, it sounds like the Liberty mask is working for her except for the leaks right? Try doing a search on this site for Mirage Liberty and there may be some novel ideas for keeping the nasal pillows in her nose.

concerned mom,

You need to ditch the Liberty mask, it wasn't designed to handle the pressures related to Non-Invasive Ventilation (NIV), and I suspect this is why the pillows are comming out of her nose.

respironics has a new mask out called the PerforMax, it is not currently being marketed to HME's, but THEY CAN GET THEM.
Here is a link to the website, once you see it you will understand why I would suggest this for your daughter.
http://performax.respironics.com/

In the mean time, you need to get her back onto a fullface mask, there are many products out there which can help to minize or eliminate entirely the pressure sores your daughter has been experiencing. Call some of the local hospitals and see if any of them have a wound care nurse/specialist that you can talk to.

Feel free to ask any other questions, there are no dumb ones.

Ask her doctor how long will she need to be on night-time ventilation. If it is for an extended period of time, it could be an option to have a trach & ventilate through the trach at night & when needed during the day. The trach's balloon can be deflated & then the opening capped for when she is not being ventilating. Just an option to discuss with her doctor, esp. since the masks are a problem. Also with the trach, the pressure support levels could be decreased since less pressure is needed when the upper airway is bypassed.

RRT in GA

That was suggested by the drs. when we were leaving the hospital, but she is so active during the day and I would hate to go that route unless it was a matter of survival. My older daughter is a physical therapist and has seen many patients who have trachs. She told me they are also not easy to maintain, the patients needs suctioning, infections are common and to be honest, I feel it is the most invasive way of ventilating. One of her other doctors, Dr. John Bach, feels trachs should only be done if the patient cannot talk or eat because of respiratory distress. He is big on non-invasive ventilation. We are trying hard here. It's very difficult, but it seems many people using masks at night are having similar problems. Thanks for your input. I really do appreciate everyone's comments and advice.

Other leak remedy measures I encounter here include:

Clean mask and face of all facial oils.

Some have taken Macks silicone ear plugs, rolled them into thin worm shapes, and installed them on the mask to custom fit and seal leaks.

Hope things improve quickly for you.

Georgio

Nice machine

It seems to hav a variety of modes (pressure control & pressure support) PC is like timed mode & PS is adjustable pressure based on either Minute Ventilation or Flow.

My 1st thought is that at 17 BPM, the rate is close to hyper-ventilation - but I guess that is one way to reduce PCo2 level.
Tidal Vol (Vt) of 700ml is pretty healthy (mine is around 600-700 as a big breathing adult).

I am wondering if the doc is willing to adjust risetime to slow the rate of rise a bit as that can impact leaking.

Good luck

DSM

concerned mom, see if they'll let your daughter try a ResMed Ultra Mirage Full Face mask. Ask them to give you several sizes to try at home...not to just "fit" one to her at the home health care office. I'd want to try these cushion sizes at home: "Small Shallow", "Small Standard", "Medium Shallow", and "Medium Standard." All those cushion sizes fit the one mask frame. The cushions snap in and out.

Also check out the "Lab Rat Awards" page for fixes people have come up with for various masks. Look at the modifications for masks that are not even the one she uses. Many fixes can be adapted to other masks, or might give you ideas for ways to make the mask more comfortable or less leaky:

LINKS to Lab Rat Trophy awards
viewtopic.php?t=15104

Whichever mask you use, be sure to soak it in soapy water for 30-60 minutes before its first contact with your daughter's face. Some people have allergic reactions to whatever is left on the mask after it is produced. I had "carpet burns" on my face with my first masks because of that. Washing was not enough.

O.

you might try a fisher and paykal oracle. it is an oral mask, not many have tolerated this mask, but those who can love it. I don't know where you live, or who your provider is, this mask can be made non invasive, there is no place for leaks, you have to begin with nose plugs until she has retrained herself to breath from her mouth, but then she can quit using them. Most can quit using the headgear after a week or so.
If she has a neuromuscular disease, do much research before you decide to trach her. Talk to your doctor about trying Pressure support instead of volume control, it is closer to natural breathing. Neuromuscular pt do much better with pressure control/pressure support