Vent - What Doctor Decided

Madalot · Post by **Madalot** » Sat Apr 03, 2010 6:37 pm

newhosehead wrote:Kathy,
Any progress with getting your van fixed?
Jeanette

Not yet. My husband is going to drive it Monday the 80 miles to the dealership for them to fix. I hate the idea of him driving it because it's stuck in the "kneel" position (meaning the van is tilted to one side). They've assured us it won't hurt it to drive it that way, but I have my concerns. In the meantime, I really can't go anywhere that I would get out of the vehicle since that's the only way we have to transport my powerchair.

Madalot · Post by **Madalot** » Sun Apr 04, 2010 6:34 am

I thought I'd come back into this thread and give an small update. I guess I'm over my "screw this I'm tired of dealing with it" mind frame. Sorry -- I get that way sometimes.

Last night was bad and kind of ticked me off. I think I'm going to have to talk to my RT about trying the Auto-Trak setting to see if it will make any difference. The "arguments" me and vent are having are getting more frequent. Figures. That's the way it always goes with me -- seems to be "okay" for a day or so, them BOOM!! The problems start to increase.

:::sigh::: I guess I'll place a call to her tomorrow -- if she's even working. People around here tend to take the Monday after Easter off as a holiday. Kind of weird to me, but a lot of places will be closed tomorrow.

But I'll try to call her.

-SWS · Post by **-SWS** » Sun Apr 04, 2010 9:37 am

Everything at your own pace, Madalot... And therapeutic venting about vents works well here as well IMO.

Madalot · Post by **Madalot** » Mon Apr 05, 2010 6:56 am

-SWS wrote:Everything at your own pace, Madalot... And therapeutic venting about vents works well here as well IMO.

Yeah, I realized when someone posted that they were "venting" with a subject line using the word "vent" that I might want to start spelling it out!! LOL

I believe it would be prudent to talk with my RT/doctor about making some of the adjustments discussed in this thread. Perhaps switching to the Auto-Trak just to see if it will make my inhale/exhale more comfortable.

I have done two nights using the CMS-50F wrist pulse ox monitor and according to that, I am doing quite well overnight. The first night, my lowest oxygen level was 93%. Last night it dropped to 91%, but that's still more than acceptable.

So it would seem that THERAPY wise, I'm doing very well. Now if we can just do a little more tweeking to get that effective therapy more comfortable.

I'll talk to my RT/doctor about this and start a new thread IF she agrees to let me try Auto Trak or perhaps suggests something else.

jnk · Post by **jnk** » Mon Apr 05, 2010 7:28 am

My vote might still be for higher maximum Ti, to settle the arguments between you and your machine, if they are still occurring, especially if O2 is doing OK.

I only feel free to say that, though, because you are well aware (hopefully) that I don't know what I'm talking about with this kind of stuff. I'm only throwing ideas around based on my personal experience fighting with my autobilevel.

jnk in another thread wrote: . . . I NEED a maximum inspiration time set at over 2.0 seconds on my bilevel or else I will occasionally not have enough time to finish breathing in before my machine cycles to breathe-out pressure and wakes me up, even when I have no leak. For that reason, I keep my maximum inspiration time set over 3.0 seconds. Of course my situation is VERY different from yours. But I thought you might find that interesting anyway.

jeff

-SWS · Post by **-SWS** » Mon Apr 05, 2010 7:33 am

jnk wrote: My vote might still be for higher maximum Ti, to settle the arguments between you and your machine, if they are still occurring, especially if O2 is doing OK.

I agree that lengthening inspiration time would be a good thing to consider if the machine is still transitioning to EPAP too early. However, if the problem is that the machine is transitioning to IPAP too early, then there's probably no reason to lengthen the back-end of inspiration by increasing Ti. Madalot, is your machine still: a) transitioning to IPAP too early, b) transitioning to EPAP too early, or c) both?

Madalot wrote:I have done two nights using the CMS-50F wrist pulse ox monitor and according to that, I am doing quite well overnight. The first night, my lowest oxygen level was 93%. Last night it dropped to 91%, but that's still more than acceptable.

That sounds great, Madalot.

Madalot wrote:So it would seem that THERAPY wise, I'm doing very well. Now if we can just do a little more tweeking to get that effective therapy more comfortable.

I'll talk to my RT/doctor about this and start a new thread IF she agrees to let me try Auto Trak or perhaps suggests something else.

I agree that you have two main objectives to iron out: 1) maintaining sufficient oxygenation, and 2) maintaining sufficient quality of sleep (without the vent being too sleep-disruptive) They're both important IMO. On that basis getting your Trilogy settings as comfortable as possible without sacrificing oxygenation is the right thing to do. Additionally, your body might continue to become more and more comfortable with the Trilogy backing up your breaths.

Madalot · Post by **Madalot** » Mon Apr 05, 2010 7:35 am

jnk wrote:My vote might still be for higher maximum Ti, to settle the arguments between you and your machine, if they are still occurring, especially if O2 is doing OK.

I only feel free to say that, though, because you are well aware (hopefully) that I don't know what I'm talking about with this kind of stuff. I'm only throwing ideas around based on my personal experience fighting with my autobilevel.

jnk in another thread wrote: . . . I NEED a maximum inspiration time set at over 2.0 seconds on my bilevel or else I will occasionally not have enough time to finish breathing in before my machine cycles to breathe-out pressure and wakes me up, even when I have no leak. For that reason, I keep my maximum inspiration time set over 3.0 seconds. Of course my situation is VERY different from yours. But I thought you might find that interesting anyway.

jeff

Thanks Jeff. I've been sitting here thinking (dangerous, I know). You may be right about changing the Inspiration Time. But it's also possible that I need to increase the Rise Time too. Not only that, I'm beginning to WONDER if the minimum inhale pressure of 6 is too low.

Ugh -- too many things to think about. This would be so much easier if I could just play with these settings myself. Unfortunately, I'm not allowed to and since I made that promise to the owner of the DME, I am stuck having to discuss with my RT/Doctor before making any changes.

Not only that -- I went and just looked to see if the machine was set up as Passive. Don't you know that the darned "Event Log" showed me accessing that menu!!! That could be bad for me when they download, but hopefully because I just looked and didn't make any changes, they'll be okay with it.

Banned · Post by **Banned** » Mon Apr 05, 2010 7:42 am

-SWS wrote: Madalot, is your machine still: a) transitioning to IPAP too early, b) transitioning to EPAP too early, or c) both?

Madalot wrote: Last night was bad. And it DID seem that it was forcing air on me more often when I was trying to exhale.

Madalot · Post by **Madalot** » Mon Apr 05, 2010 7:43 am

-SWS wrote:
jnk wrote: My vote might still be for higher maximum Ti, to settle the arguments between you and your machine, if they are still occurring, especially if O2 is doing OK.
I agree that lengthening inspiration time would be a good thing to consider if the machine is still transitioning to EPAP too early. However, if the problem is that the machine is transitioning to IPAP too early, then there's probably no reason to lengthen the back-end of inspiration by increasing Ti. Madalot, is your machine still: a) transitioning to IPAP too early, b) transitioning to EPAP too early, or c) both?

Madalot wrote:I have done two nights using the CMS-50F wrist pulse ox monitor and according to that, I am doing quite well overnight. The first night, my lowest oxygen level was 93%. Last night it dropped to 91%, but that's still more than acceptable.
That sounds great, Madalot.

Madalot wrote:So it would seem that THERAPY wise, I'm doing very well. Now if we can just do a little more tweeking to get that effective therapy more comfortable.

I'll talk to my RT/doctor about this and start a new thread IF she agrees to let me try Auto Trak or perhaps suggests something else.
I agree that you have two main objectives to iron out: 1) maintaining sufficient oxygenation, and 2) maintaining sufficient quality of sleep (without the vent being too sleep-disruptive) They're both important IMO. On that basis getting your Trilogy settings as comfortable as possible without sacrificing oxygenation is the right thing to do. Additionally, your body might continue to become more and more comfortable with the Trilogy backing up your breaths.

Hey -SWS,

I almost missed this post! I'm having to be very careful about double checking responses.

I'm having a hard time distinguishing what the actual problem is. All I can tell you for certain is that there are times that I'm trying to inhale and the ventilator isn't giving me air. There are also times I'm trying to exhale and its pushing air. It's not constant and I find, if I'm still awake, I adjust MY breathing to work better with the vent. But if I'm asleep and this happens, I guess the vent wins.

These issues are becoming more frequent. So, I'm really not sure what the answer is.

And I am still waking up every morning around 3 or 4am and when I look at the monitor, the pressure is up between 18-20 at that point. It happens every night. I've asked my doctor about this and she hasn't responded as of yet.

I think you're right that we've got two things to deal with: 1) keeping my oxygen level up, which it APPEARS we've gotten under control; and 2) making it comfortable for me so I sleep well without arguing with the vent. This one still needs a bit of tweeking.

Banned · Post by **Banned** » Mon Apr 05, 2010 8:16 am

Madalot wrote:All I can tell you for certain is that there are times that I'm trying to inhale and the ventilator isn't giving me air.

Trigger problem

Madalot wrote:There are also times I'm trying to exhale and its pushing air.

Decrease Inspiration Time

Madalot · Post by **Madalot** » Mon Apr 05, 2010 8:20 am

Banned wrote:
Madalot wrote:All I can tell you for certain is that there are times that I'm trying to inhale and the ventilator isn't giving me air.
Trigger problem

Madalot wrote:There are also times I'm trying to exhale and its pushing air.
Decrease Inspiration Time

I see what you're saying, but there ARE times that it's really good and comfortable. Most of the time anyway. It's just those few times that it's not comfortable.

Madalot · Post by **Madalot** » Mon Apr 05, 2010 9:03 am

I just sent an email to my doctor and RT, trying my best to explain what I think it happening and asking if there are settings we can play with to try to alleviate the inhale/exhale arguments I'm having. Once I hear, I'll start a new thread to let you all know what they said.

-SWS · Post by **-SWS** » Mon Apr 05, 2010 9:27 am

Banned wrote:
-SWS wrote: Madalot, is your machine still: a) transitioning to IPAP too early, b) transitioning to EPAP too early, or c) both?
Madalot wrote: Last night was bad. And it DID seem that it was forcing air on me more often when I was trying to exhale.

Thanks, Banned. However...

Banned wrote:
Madalot wrote:All I can tell you for certain is that there are times that I'm trying to inhale and the ventilator isn't giving me air.
Trigger problem

Madalot wrote:There are also times I'm trying to exhale and its pushing air.
Decrease Inspiration Time

A trigger problem means the EPAP-to-IPAP transition isn't working. But that's not what Ti fixes. Rather, decreasing/increasing Ti deals with when the machine allows the OTHER transition----the IPAP-to-EPAP transition----to occur.

You fix trigger problems with adjustments to either BPM or the trigger settings. Madalot's S/T BPM is already set low enough to allow for ample latitude. So that means the machine's trigger settings need to be adjusted (assuming mask leaks are under control). And the next trigger adjustment I would try is AutoTrak...

Madalot · Post by **Madalot** » Mon Apr 05, 2010 9:32 am

-SWS wrote:
Banned wrote:
-SWS wrote: Madalot, is your machine still: a) transitioning to IPAP too early, b) transitioning to EPAP too early, or c) both?
Madalot wrote: Last night was bad. And it DID seem that it was forcing air on me more often when I was trying to exhale.
Thanks, Banned. However...

Banned wrote:
Madalot wrote:All I can tell you for certain is that there are times that I'm trying to inhale and the ventilator isn't giving me air.
Trigger problem

Madalot wrote:There are also times I'm trying to exhale and its pushing air.
Decrease Inspiration Time
A trigger problem means the EPAP-to-IPAP transition isn't working. But that's not what Ti fixes. Rather, decreasing/increasing Ti deals with when the machine allows the OTHER transition----the IPAP-to-EPAP transition----to occur.

You fix trigger problems with either BPM or the trigger settings. Madalot's S/T BPM is already set low enough to allow for ample latitude. So that means the machine's trigger settings need to be adjusted (assuming mask leaks are under control). And the next trigger adjustment I would try is AutoTrak...

To the best of my knowledge, my leaks are pretty well under control -- most of the time. I do much better with the F&P 431. I have a Respironics FF Comfort Gel that leaks like a sieve -- it was awful.

I suspect I'll hear from my RT before my doctor and I will ask her about these things -- can we try them to see if it makes any difference.

I think one of the things I'm dealing with is that I'm using a ventilator and because it's a ventilator, they are ADAMANT about me not playing with settings. So, it's frustrating because the things we are discussing here seem like pretty "calm" things to try, but I'm just not allowed to play with the settings. It took me almost 2 weeks to get approval to make the two changes we just made.

-SWS · Post by **-SWS** » Mon Apr 05, 2010 9:37 am

Well, in summary: 1) trigger controls adjust when IPAP begins, and 2) Ti or "inspiratory time" adjusts when IPAP ends.

Madalot wrote:I think one of the things I'm dealing with is that I'm using a ventilator and because it's a ventilator, they are ADAMANT about me not playing with settings.

I agree that you need to work all adjustments through your clinicians. Good luck, Madalot!

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