Trilogy 100 settings

If we want to get a bit technical, min epap/peep pressure is for recruitment of the alveolar or air sacks semi-inflated and not collapsing. But a general term of holds the lung open is close enough for understanding.
This is more than likely, the reason the pressure was set at epap 12 and why it could be bad to reduce it. google: alveolar recruitment peep copd

For those of us that can remember, initially it is a funny feeling. When the pressure holds the lung open and it feels like you don't fully breathe out. The concern with caregivers wife is that there isn't branch stacking, where there is a real case of not getting the volume out before the ventilator gives another breath. The lung ends up over inflated. The odds of them doing a titration and then setting the machine wrong is small, but it does happen.

caregiver hasn't replied for a while. Hopefully the matter has resolved, or they sort medical assistance.

Hello,
Thanks to everyone for there response to my wife’s situation. Trying to understand all the terms and numbers associated with the Trilogy can be quite overwhelming. Meeting with Dr. on Wednesday to go over the settings and see what can be done to make the wife more comfortable.

It is hard for a new user to go straight to epap 12, min ps 4. It can take a couple of months to adjust to it. Sometimes just keeping the mask on all night is an effort at first. Hopefully they set the machine up right, or can adjust it to feel better.

Hello,
Just wanted to give a brief update, had a good talk today with the wife’s Dr. about making changes to her Trilogy settings. Will go into more details tomorrow. Thanks again for everyone’s input.

The AVAPS rate of 5cm h2o is most likely not necessary and will likely be uncomfortable. AVAPS was never really designed for rapid IPAP changes. It will be better to tighten up the range of PS min and max so that the machine isn't constantly changing the IPAP pressure in a dramatic fashion in order to maintain the target tidal volume. Ideally, the IPAP pressure should be adjusting smoothly - largely when asleep - so that the user remains undisturbed. Trying to fall asleep when the IPAP is swinging back and forth is a challenge.

Further, a PS min of 4 will do practically nothing to assist in ventilating someone with an airway disease. There are studies that show low-intensity ventilation leads to higher rates of acute exacerbations and hospitilations in people with COPD. Of course, you want to acclimate to the higher pressures, so you can start slow and work your way up.

I would experiment by enabling the flow trigger and not using Auto-trak. Odds are with Auto-trak it is prematurely cycling from IPAP to EPAP because the trigger is so sensitive. With the flow trigger you can set the sensitivity between 1 - 9 (1 being the most sensitive), so a lot more customization. You can then also change the cycle sensitivity setting - the lower the percentage (I believe 10%) is the lowest, the longer the inhalation cycle will last). Don't make the cycle too long because with COPD you run into the danger of breath stacking/air being trapped. I believe you want around a 1:3 inhale to exhale ratio in the case of COPD.

Lastly, where did the EPAP of 12 come from? With COPD her EPAP will need to be somewhat high due to Auto-Peep, but does she actually have documented discrete obstructive apneas on a sleep test? Ideally, if not necessary, the EPAP being lower is helpful so that you can keep the IPAP levels lower as well and keep the same amount of pressure support.

I would adjust her settings for sure. If she can tolerate AVAPS-AE mode, aka the forced oscillations, maybe set EPAP min to 8 and EPAP max to 14. I would up PS min to at least 8, and put PS max at 16 - ideally you don't want to go over an IPAP of 30 cm h2o, unless required to maintain target tidal volume. Sometimes just upping the IPAP/PS min alone helps even things out.