AVAPS-AE on MY Trilogy - Ongoing

Pulmonette · Post by **Pulmonette** » Mon Sep 02, 2013 3:37 pm

I mean the episodes occur once per minute, so there are like dozens of these things.

-SWS · Post by **-SWS** » Mon Sep 02, 2013 3:42 pm

Ah... perhaps Madalot can check episode frequency and report back....

I have a hypothesis to add---an offshoot of the faulty-valve hypothesis. These pulsations are occurring only during exhalation. I see the Trilogy should be fit with either an active-exhalation port block or a passive-exhalation port block. Madalot needs a passive-exhalation port block. I wonder if this loaner machine has the wrong port block? Alternately, I wonder if the exhalation port block needs to be reseated?

Madalot · Post by **Madalot** » Mon Sep 02, 2013 3:48 pm

I will try to answer all your questions, but I'm doing this from my car on my phone.

If I'm lucky, I'll get my trilogy back mid-october. But I have no hopes that I'll get it that soon.

Other than checking to the best of my ability, I have not checked the mask. If that is likely the culprit, I can get a new one out tonight and see if that makes any difference.

This is not a heated hose. I have two hoses that I rotate weekly. I use a hose cover. I have not seen any problems with either hose, but can double check to make sure nothing is wrong. I can also get a new hose out if you think that might be helpful.

-SWS · Post by **-SWS** » Mon Sep 02, 2013 4:22 pm

-SWS wrote:I see the Trilogy should be fit with either an active-exhalation port block or a passive-exhalation port block.

Pulmonette, do you know if these exhalation port blocks are fitted ONLY when servicing the Trilogy:

Active Exhalation Porting Block with PAP (RI p/n 1054670)
Passive Exhalation Porting Block (RI p/n 1040372)

If they are not fitted during normal operation, then we can cancel the porting-block hypothesis...

Edit: I see there's also a Universal Porting Block (RI p/n 104370)... If the porting blocks are only fitted by a tech for servicing, then no-go on this hypothesis. If the exhalation porting blocks are also fitted during normal operation, then a faulty/unseated/incorrect exhalation block might explain Madalot's pulsations during exhale: there's a partial or intermittent breach through the port during exhalation rather than a block.

-SWS · Post by **-SWS** » Mon Sep 02, 2013 5:01 pm

As it turns out the exhalation porting block is used during normal operation:
http://trilogy100.respironics.com/clinical/faq.aspx#2

These unwanted pulsations are limited to the exhalation phase. They also manifest on the leak graph. I'm definitely favoring the hypothesis that Madalot's Exhalation Porting Block is faulty, poorly seated, or of the incorrect type. It doesn't always block during exhalation.

Madalot, if the Exhalation Porting Block is the problem, then your DME should be able to rectify it without sending the loaner Trilogy in for service....

Madalot · Post by **Madalot** » Mon Sep 02, 2013 5:16 pm

-SWS wrote:Madalot, if the Exhalation Porting Block is the problem, then your DME should be able to rectify it without sending the loaner Trilogy in for service....

Could be coincidence, but this was not happening on regular AVAPS. Happened either the first or second night on AVAPS-AE. If port is faulty, shouldn't it be happening in regular AVAPS as well? If so, should I sleep on regular AVAPS a night and see? Only difference between AVAPS & AVAPS-AE settings is EPAP at 9 vs Max EPAP at 10 and Flow Trigger vs Auto Trak.

And if something IS wrong with the Trilogy requiring service the DME can't provide in the field, they don't have another one. This is THE backup unit they have.

-SWS · Post by **-SWS** » Mon Sep 02, 2013 5:34 pm

Madalot, see if you can replicate the pulsing by giving the machine different exhalation patterns. Here are a couple patterns to try:
1) forceful exhalation immediately after inhalation
2) inhalation, then hold breath, then forceful exhalation

If you can replicate the unwanted pulsing with a certain pattern, then try that same test pattern in ordinary AVAPS mode...

Madalot · Post by **Madalot** » Mon Sep 02, 2013 5:50 pm

No problem. I'll "go back" early enough to try what you suggest.

Interestingly, last night, during one of these pulsing episodes, I tried forceful exhaling to see if the pulses would stop. First time they did. Next exhale they didn't stop no matter how hard I exhaled.

I'll post later after I try duplicating the pulses.

Pulmonette · Post by **Pulmonette** » Mon Sep 02, 2013 5:52 pm

-SWS wrote:If the exhalation porting blocks are also fitted during normal operation, then a faulty/unseated/incorrect exhalation block might explain Madalot's pulsations during exhale: there's a partial or intermittent breach through the port during exhalation rather than a block.

Porting Blocks: Check O-Rings around the porting blocks for cracks, wear, or incorrect fit. Lubricate or replace the porting block as necessary.

Madalot · Post by **Madalot** » Mon Sep 02, 2013 6:15 pm

Please forgive my ignorance. But where on the trilogy should we look for this?

mollete · Post by **mollete** » Mon Sep 02, 2013 6:42 pm

http://www.healthcare.philips.com/pwc_h ... 084580.pdf

Page 24 and 25.

However, it would seem that there should have been a bunch of E291 codes if the block was displaced, leaking, etc.

TS, given the intensity of events, it sure seems that's where the problem is.

TS2, this is rapidly turning into a having them fix it issue.

mollete · Post by **mollete** » Mon Sep 02, 2013 6:51 pm

History of this machine since 1/6/2012:

Code: Select all

COUNT  ERRCODE      Log 17 (Encrypted Significant Event Text)
    1  E-053   ERR_HIGH_VTE_ALARM  HIGH_ALARM
    1  E-054   ERR_LOW_VTE_ALARM  HIGH_ALARM
   41  E-072   ERR_MMC_SD_CARD_INSERTED  BEEP_ONLY
   10  E-074   ERR_MMC_SD_CARD_REMOVED  BEEP_ONLY
  102  E-110   ERR_LOW_PIP_ALARM  HIGH_ALARM
    1  E-111   ERR_HIGH_RATE_ALARM  HIGH_ALARM
    1  E-114   ERR_LOW_MIN_VENT_ALARM  HIGH_ALARM
    3  E-118   ERR_LOW_CIRCUIT_LEAK_ALARM  HIGH_ALARM
   11  E-120   ERR_APNEA_ALARM  HIGH_ALARM
    8  E-121   ERR_PATIENT_DISCONNECT_ALARM  HIGH_ALARM
   18  E-165   ERR_LOW_PEP_ALARM  HIGH_ALARM
   67  E-166   ERR_UI_RESET_KEY_PRESS  KEYPRESS
   17  E-167   ERR_UI_HIDE_KEY_PRESS  KEYPRESS
   73  E-168   ERR_UI_AUDIO_PAUSE_KEY_PRESS  KEYPRESS
    9  E-169   ERR_HIGH_PIP_STAGE1_ALARM  BEEP_ONLY
    1  E-170   ERR_HIGH_PIP_STAGE2_ALARM  MED_ALARM
    1  E-171   ERR_HIGH_PIP_STAGE3_ALARM  HIGH_ALARM
   22  E-173   ERR_START_ON_BATTERY  INFO_ALARM
  145  E-179   ERR_PWR_REDUCTION_AC_DISCONNECTED  MED_ALARM
    1  E-180   ERR_PWR_REDUCTION_LEAD_ACID_DISCONNECTED  INFO_ALARM
    1  E-181   ERR_PWR_REDUCTION_DET_LI_ION_DISCONNECTED  INFO_ALARM
    2  E-250   ERR_LEAD_ACID_BATT_CONNECTED  BEEP_ONLY
   34  E-251   ERR_DET_LI_ION_CONNECTED  BEEP_ONLY
   31  E-252   ERR_INT_LI_ION_CONNECTED  BEEP_ONLY
   31  E-264   ERR_MENU_BYPASS_ACTIVATED  KEYPRESS
    1  E-283   ERR_SW_UPGRADE_PERFORMED  KEYPRESS
  127  E-284   ERR_PWR_UPGRADE_AC_IN_USE  BEEP_ONLY
    4  E-286   ERR_PWR_UPGRADE_DET_LI_ION_IN_USE  BEEP_ONLY
    3  E-291   ERR_CIRCUIT_CHECK  HIGH_ALARM
   94  E-293   ERR_POWER_OFF_KEY  KEYPRESS
   89  E-294   ERR_POWER_OFF_YES_KEY  KEYPRESS
   89  E-324   ERR_POWER_ON  KEYPRESS

COUNT  ERRCODE      Log 18 (Encrypted Engineering Debug Text)
    1  E-018   ERR_DSP_DC_DC_CONTROL  LOG_ONLY
   31  E-034   ERR_DSP_EXT_POWER_UP_SYSTEM_INIT  LOG_ONLY
    1  E-035   ERR_DSP_SOFTWARE_RESET_SYSTEM_INIT  LOG_ONLY
   32  E-055   ERR_VOLUME_LEAK  LOG_ONLY
    9  E-057   ERR_THREAD_STACK_RESERVE  LOG_ONLY
   19  E-096   ERR_CALIBRATION_CONTROL  LOG_ONLY
   41  E-117   ERR_MMC_SD_DRIVER_ERROR  LOG_ONLY
    1  E-124   ERR_REBOOT_ACTIVATED  REBOOT
   15  E-140   ERR_NVDATA_READBACK_ATTEMPT  LOG_ONLY
  426  E-148   ERR_DEBUG  LOG_ONLY
    1  E-151   ERR_SW_UPGRADE_STARTED  LOG_ONLY
   32  E-152   ERR_POWER_UP_SYSTEM_INITIALIZATION  LOG_ONLY
    1  E-170   ERR_HIGH_PIP_STAGE2_ALARM  MED_ALARM
    1  E-171   ERR_HIGH_PIP_STAGE3_ALARM  HIGH_ALARM
    2  E-248   ERR_INFORMATION  LOG_ONLY
  145  E-249   ERR_AC_CONNECTED  LOG_ONLY
    1  E-259   ERR_SHIPMODE_SUCCESSFUL  LOG_ONLY
    3  E-291   ERR_CIRCUIT_CHECK  HIGH_ALARM
   32  E-297   ERR_SLEEP_EVENT  LOG_ONLY
    3  E-298   ERR_WAKEUP_EVENT  LOG_ONLY
    2  E-310   ERR_CAL_DATA_WRITE  LOG_ONLY
    1  E-329   ERR_RTOS_HEAP_FRAGMENT_RESERVE  LOG_ONLY
    1  E-336   ERR_INT_LI_ION_EXITED_SHIP_MODE  LOG_ONLY
  131  E-341   ERR_FAN_CONTROL  LOG_ONLY
   19  E-365   ERR_MMC_SD_DRIVER_DEBUG_MESSAGE  LOG_ONLY

Madalot · Post by **Madalot** » Mon Sep 02, 2013 7:15 pm

This loaner machine has had all those errors in just under 2 years? Would the patient or user been aware of them? Is there any point in doing more testing to see if there's something else going on or should I not worry about it at this point and just wait for my trilogy to come back?

mollete · Post by **mollete** » Mon Sep 02, 2013 7:21 pm

Porting block adapter connections and caps:

-SWS · Post by **-SWS** » Mon Sep 02, 2013 7:23 pm

mollete wrote:http://www.healthcare.philips.com/pwc_h ... 084580.pdf

Page 24 and 25.

However, it would seem that there should have been a bunch of E291 codes if the block was displaced, leaking, etc.

TS, given the intensity of events, it sure seems that's where the problem is.

TS2, this is rapidly turning into a having them fix it issue.

I suspect the problem's intermittency relative to diagnostic code's infrequency of execution explain the lack of error-log entries: every time the intermittent problem crops it's head, that particular leg of diagnostic code is probably NOT running.

Glad to see you, Mollete.

AVAPS-AE on MY Trilogy - Ongoing

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