NON-INVASIVE
VENTILATION (NIV)
From Bi-pap to C-pap and
everything in between
So, what is non-invasive ventilation all about? Well you have come to the right place to find out.
Ventilation for Acute Respiratory Failure in COPD Patients Has Good Initial Outcome
Incidence of Nocturnal Desaturation While Breathing Oxygen in COPD Patients
Predictors of Outcome for Patients With COPD Requiring Invasive Mechanical Ventilation
Underestimation of Nocturnal Hypoxemia Due to
Monitoring Conditions in Patients With COPD
First of all you
must forget the commonly held belief many doctors and patients
have. That is that to
use a ventilator
successfully you must use it invasively with a tracheotomy. This
page will show you
how a ventilator
can be used non invasively.
Secondly and most importantly in order to avoid being forced into
invasive ventilation you must not
wait until you
absolutely need to use a ventilator . You must plan ahead. Don't
wait to long to seek
help if you are
developing breathing difficulties. If you wait until you are in
an emergency such as heart
failure or
respiratory failure most likely you will be trached.
For me respiratory difficulties developed gradually. At first I
only needed breathing assistance
overnight. Then I
began using the ventilator several hours during the daytime also,
until eventually I got
to the point where
I am now. Currently I am only able to breath 5 to 15 minutes at
the most
on my own before I
need assistance. When I began having difficulty breathing I
didn't want to be using
a ventilator with
a trach. Fortunately the first respiratory doctor I went to see
didn't believe in invasive
ventilation for
people with my condition. She specialized in non-invasive
ventilation. She set me up
with my first
ventilator equipment. Additionally I began to breath in a unique
way over a period of
time. Because I
developed breathing difficulty slowly I began to compensate for a
low breath capacity
by in essence
gulping air at the end of every breath. Using neck muscles and
ones' lounge you can
increase your
vital capacity to a point where you can sustain your breathing
adequately enough to
breath on your own
for longer periods of time. My story is here
How to Perform Your Own Search on the Health Sciences Library's Ovid Search System
Non Invasive Ventilation (BiPAP)
Nighty Night Mikie!!!! Sweet Dreams thanks to bi-pap
|
Native Texan < mikiekey@attbi.com>
Subject: Re: [COPD] BIPAP
comment
Tony gave a good description of the BIPAP
machine. I would want to add that originally they fitted me
with a CPAP (constant air
pressure, no allowance for exhaling) and I
could not adapt to it because I could not fight the pressure of
the incoming air to exhale
properly, thus making me feel as if I were
being suffocated! Once I explained this to my pulmonary
doctor, he ordered a BIPAP for me
(BIPAPs are more expensive but allows you
to breathe OUT as well as helping the inward movement). I really
become "one" with
it UNLESS I have sinus troubles then the
setting doesn't work. For instance last night my sinuses
were really stuffy, I ended up
taking the BIPAP off and just wearing O2
from the concentrator. I hear so many people say they never
have a problem with it and
that's not true for all of us. It's
certainly worth the effort when it's in sync with you, and that's
most of the time. I use the BIPAP
because I have severe sleep apnea, stopping
breathing (respiratory disturbance index of 58 events per
hour). My PCP ignored my
requests for sleep testing for years, and
YES I think it affected my short term and long term
memory....think it's due to lack of O2,
as my sat levels were low too. I
don't use O2 at night with the BIPAP because the air movement
gives me a boost enough that I
don't need it.
The BIPAP's primary purpose for my needs is
to keep the airways open, not associated with the
emphysema. The sleep apnea
continually closed my throat due to
collapsing, which caused the sleep trauma. During these
"events" my O2 went to the high 80s,
but when the machine was hooked up to me
the O2 went up to an acceptable level (or so I am told), and
there has been one in
home test to show that I didn't need O2
with BIPAP. IF the BIPAP had not worked out, then yes I would be
on O2 at night. but
the ideal situation was for the BIPAP to
work and thereby only need that at night. I do think that I
should wake up more rested
than I do, but that's just my
opinion. Masks are a BIG deal with these
CPAPs/BIPAPs! I bought a Gold Seal thinking that I might
improve over the Mirage...that was a
mistake! Insurance is funny about paying for the better
masks to I went to a website that sold
them for a reasonable price and bought
another Mirage (still have not put it into service as the old one
keeps going). You might
want to visit this website for good prices
on masks and other equipment: http://www.owt.com/conjo/index.htm
This may get your on the parts page where
you can find item #16502 Mirage. Complete System
$131. (I don't get a commission,
just recommending) http://www.cpapman.com/supplies.htm
Mike in Dallas (Native Texan) mikiekey@attbi.com
Lee with his full face
mask LFIELD <LField@TRIAD.RR.COM>
This is a full faced mask and is most
usefull if you are a mouth breather or sleep with your mouth
open.
Full faced mask provide an excellent seal.
Lee Field
|
|
I am 76 years old WWII
veteran. I have moderate COPD and severe Sleep Apnea. I have
a Sullivan Bi-Pap with a Sullivan
heated Humidifier. My experience can only
be described as Bi-Pap Hell. It all began after two
excursions to a Sleep Lab
(Named after a favorite black dog of some
forgotten, thank heavens, Doctor)
I had a heck of a
time. They first gave me a Respironics "Gold Seal" mask
that just covered my nose. It had two wide blue
straps that fit over your head. I am a
"mouth breather", which I did not know or ever heard
about so the mask had to be
implemented with a strap that went under my
chin and over my head, in order to keep my big mouth shut.
This was so uncomfortable that I was losing
more sleep than gaining any good the mask and Bi-Pap was supposed
to help
..After going on the "web: and finding
such places as Olivija.com and cpapman.com, I went to my
pulmonary doctor without an
appointment and abley raised cain.
I told him that I could
not wear such a contraption and that he should have known better.
He called the Medical Supply
people and told them that if they did not
help me that he would no longer recommend them. It worked. I went
to the Med
Supply and they gave me a ResMed
"Mirage Full Face Medium Mask System". This consisted
of the mask and a flimsy
sort of black strapping that was somewhat
similar to the blue straps of the Gold Seal. but much thinner and
not as
comfortable. It covered my mouth and nose
so that solved the problem of being a mouth breather,
although you do get very dry if you
continue breathing thru your mouth. I put up with this for quite
a while, waking up at
night, adjusting it and then trying to go
back to sleep. This black harness was just not good for me
although the Mirage Full
Face Mask was a
winner. So I cut up the black harness and
tried doing away with the meshing and the piece over the top of
the head. Still not
as comfortable as it should be and still a
pain in the ears. I then had the bright idea of using the wide
blue straps of the Gold
Seal nose mask with the Mirage. I again cut
the webbing, making two
separate pieces. They did not fit thru the
holes in the mask as they should, but were forcible. Wow! What a
difference. The
Spironic straps with the Mirage was much
more comfortable, but of course not completely. I am an active
sleeper. I start out
on my right side, sometime during the nigh
I am on my back, and I always end up on my left side.
One day while watching
the History channel I noticed that the Fighter Pilots were
wearing their oxygen masks with one
strap down around the back of their necks.
I immediately got my mask and removed the upper strap tightened
the lower
strap pulled it down around the back of my
neck and sure enough it worked.
I have purchased a new
Mirage Face mask, but size Small. I can use one strap on this
bringing it down behind my neck. It
has the advantage of fitting under my
bottom lip and helping to keep my mouth shut.
The downside is that it is lower on my nose
so I bought some Dr. Scholl's "Moleskin Plus Padding"
(Foot Dept. any Rx) and
cut up little patches to keep my nose from
hurting.
I believe that you must
play around with the thing and get it to feel comfortable. I Have
had the Bi-Pap for 10 months and am
very comfortable with it, I even put it on
for short naps or when I am overly SOB. The main thing is to get
tough with your
Supplier and make it their job for you to
be comfortable.
Tony in Dallas
|
THamel5038@aol.com
Hi Tony here in Dallas. I was prescribed a
BIPAP/ST unit for CO2 retention on Dec 23, 1999 and have been
wearing it every night
since. It has lowered my Co2 level
considerably from 82 in Dec to 66 as of June 1st.
A BIPAP/ST stands for BiLevel Positive
Airway Pressure. The ST designates the BIPAP also has a backup
respiratory rate
incorporated. This means the unit supplies
me with forced breaths. FYI: My BIPAP settings are: - TPAP=20 -
EPAP=5 -F1O2=
1.5lpm - S/T=14 bpm. Doctors will determine
the settings for the BiLevel settings. There are two settings.
One for assisting you to
breath in and one for assisting the breath
out. This helps flush out the CO2 in your lungs. It is
something you have to get used to. I
did. But after just one or two nights, I
slept like a baby. One other thing that is very important.
The mask that is used for BIPAP
machines is most of the time a generic put
out by more than one company. Mine was custom made to fit my
particular facial features
and works very well. One thing you don't
want is the air leaking around the top of the mask into your
eyes. That is very uncomfortable
and you can get a cold in your eyes from
it. I had my mask made when they did my sleep study at an
outpatient facility lab. It was
originally like silly putty and about the
same color andthey molded it around my nose area and when it
hardened it fit perfectly and
did not leak above or below my nose and I
have a mustache. It is not hard and is easy to clean. I was
told to clean it with cold water because warm water increases the
chance for bacteria go grow. They said also to clean it with a
vinegar and water solution. Soak in
a solution of one cup vinegar and 3 cups
water. The mask is called a LYON
NASAL MASK. I believe the CPAP
is mainly for
sleep apnea. It is just a set amount
of pressure and does not have but one setting to keep the airway
open. It is sort of a hassle but in my case more of a blessing. keep on keepin' on
FYI A CPAP
unit has only one setting for a continious positive airway
pressure. It does not make you breathe as its only job is
to keep the airway open. A Standard CPAP unit maintains the same
pressure while you inhale and exhale. The constant flow of
air keeps the airway open to allow for normal breathing and
uninterrupted sleep. Some patients require a bi-level unit
which I use called a BIPAP unit and
has two seperate settings. One higher
pressure for inhalation and one lower pressure for exhalation.
These BIPAP units can also be set
to give the patient a certain number of
breaths per minute as mine does. If I do not take a breath in a
certain period of time my machine
will kick in the higher pressure and make
me take a breath 14 times per minute. This additional option is
desiganated by the indicator /ST
as in BIPAP/ST
My settings are
TPAP=20 cuH20 for inhalation
EPAP=5 cuH2) for exhalation
S/T 14 bpm
and F1O2= 2.5 lpm,,,this is the additonal
oxygen I require with my machine. I have to wear a BIPAP not due
not only due to sleep apnea but because I am a CO2 retainer and
the machine keeps the Co2 flushed out of my lungs. I also
feel very refreshed when I wake up as I think the demand setting
for breaths per minute help my lungs to relax and not work as
hard.I have lowered the Oxygen flow to 2.0 lpm as
I was retaining more Co2 with the higher
oxygen flow setting. This was done with docs approval after two
consective ABG's showing high Co2 levels. Normal is 35 to 35 and
I am at 66. I was at 77 at one time, thus the lowering of
o2 flow. This is something you have to get accustomed to as
when the forced breath cycle hits, you have to be prepared to
take a breath. Let me put it this way,,,you WIlLL take a
breath. It only took me one night to get comfortable with
the machine and the settings. You just have to relax and
not try and fight the machine. Hope this puts some light on
the difference between CPAP and BIPAP machines. keep on keepin' on
Tony in Dallas
http://www.geocities.com/thamel5038/index.html
Jackie LaBreck <jlabreck@dycon.com>
|
|
BiPAP is a machine that
has two way 'breathing'. It pushes air into your lungs when
you inhale but also lets up on the pressure when you
exhale. From what I understand, that
is the difference between CPAP and BiPAP. CPAP has
continuous pressure. Oxygen is attached to
the mask that you wear so that you still
get the same liter flow that you are use to. (If your
prescription calls for oxygen) I use BiPAP on a
daily basis for sleeping. Whether it
is at night or just napping. Since starting the BiPAP, I
have found that I don't get migraines nearly as
much as I use to and I don't wake up short
of breath unless I sleep in the wrong position. When
starting on BiPAP, you do have to get use
to wearing the mask. The respiratory
therapist told me that the best way to get use to it is to put it
on for a while and if you start feeling
claustrophobic or can't stand it, take it
off for a while, then put it back on. Basically, getting
your body use to it. I had no problems getting
use to it since, when I was put on it, I
was in respiratory distress at the time and was admitted to
ICU. Have never had a problem since
and was only in ICU for 3 days, which
wasn't even suppose to be that long but they 'just wanted to make
sure' that I was still OK. I think
BiPAP is wonderful. Although the best
mask 'holders' I have found are called Softcaps, I believe by
Respironics. Other ones that I have
used slide up and down on your head and
don't hold the mask correctly. What you will see in the
pictures is the softcap. Mine also has a
'quick release clip' so that you don't have
to keep resetting the velcro adjustment every time that you put
it on. I have only really tried two
types of masks so far and they are pretty
much the same so I don't have any real recommendations about what
type
of mask to actually wear.
Jackie LaBreck/freelady
35 yo cystic fibrosis patient
pre-tx working on getting listed
http://www.geocities.com/firstfreelady/
Essentially, we all have lost and are
progressively losing varying amounts of our lungs and it's
function. What that means is that we don't move as much
air in and out of our lungs. That in
turn means we don't bring in as much oxygen and don't move out as
much carbon dioxide. And that means we can and usually do
become short of breath.
The alternatives -------
One is to insert a tube through our neck
directly into our lungs which is attached to an air compressor
which then pumps air directly into our lungs.
It is set to essentially take over the job
of breathing for us. That is called a "Trach."
Another option is a cPaP. This is an
air compressor attached to mask covering either the nose and/or
the mouth. It's function is to prevent too
much air being exhaled that causes the
small airways to completely close. The cPaP maintains a
continuous small pressure to prevent them from closing.
Another option starts with the cPaP, but
also adds another function -- that being to replace the air flow
lost from the loss of our functioning lung tissue. That
increases the oxygen inhaled and the carbon dioxide
exhaled. That is a BiPaP which also utilizes an air
compressor to increase the amount of air inhaled through the nose
into the lungs.
The BiPaP can be set to regulate the volume
of air inhaled with each breath as well as the number of breaths
per minute. It can also be set to either
force the airflow, or just act to support
your natural breathing pattern. The new models provide a
great deal of flexibility that weren't available just a few short
years ago.
Generally speaking, a reduction in lung
capacity means not only less oxygen, but also more carbon
dioxide. And generally speaking, a higher level of
carbon dioxide more frequently triggers a
"shortage of breath" than a lower level of
oxygen. So, the objective then becomes removal of the
carbon
dioxide, which is the purpose of the BiPaP.
I've copied the literature I received from
VA when I took a BiPaP home. It simply increases the air
flow through your lungs and,
thereby, reducing and/or controlling CO2
levels. I've used one for close to 2 years now. I use
it when I sleep and I wouldn't be
without it.
It provides almost instant relief from
SOB. I can be heaving just trying to take a breath. I
put that mask on and I stop heaving
instantly. If you like to breath
easy, get the BiPaP or CPaP.
In my opinion, the non-invasive ventilation
is under-promoted, mis-understood and vastly under used.
There is nothing else, that
I am aware of, that can bring relief to
labored breathing as quickly as the BiPaP, or a variation of PaP
(Positive Air Pressure).
It almost feels like a miracle sent from
heaven to me.
Dave in Omaha
DGMcNeill@AOL.COM
I think the CPAP is mainly prescribed for sleep
apnea because patients simply quit breathing and the machine
helps to
prevent this by constantly forcing the air
into the lungs and keeping the airways open.
The BiPap for is for CO2 retainers.
It forces air into the lungs when we breathe in (the CPAP is
continuous)...pushing the CO2
out and lowering the high CO2 levels.
I used a BiPAP for high CO2 levels a couple
years ago. Couldn't stand to wear it more than about 4
hours at night....so during
the day I'd wear it while watching t.v. for
a couple hours...and that seemed to work. The trick to
using the machine is to find the
right mask so your comfortable.......
"amy " amyferiante@sprintmail.com
My mother uses the BI-pap an has for about a
month an half its a great machine she uses about 7 hours a
night not because of sleep
apnea she doesn't have that the respiratory
therapist said it gives her lungs a chance to rest an her muscles
a chance to strengthen,
also puts it on a couple hours a day or if
napping an the when she takes it off she has an easier time
breathing an also feels better it
takes about 3 -5 nights to get use to
sleeping with the contraption on your head she said but not
uncomfortable just some getting use
too, but she wouldn't take a million
dollars for her BI-pap machine,
Vickie VME02@aol.com
I used Bi-pap temporarily
for a high Co2 retention problem that I had related to Cystic
Fibrosis. I had only used this for a short
time and then the call came in. I know that
you can get used to the feeling after a while with the mask on
your face. The good
side of the mask is that you feel much
better in the morning and you are breathing better. For me
it pushed out the Co2. It
brought it down considerably. I would do it
with ease because it will save your life.
Sleep better,
Risa Gans risagans@cs.com
1.
I use mine to maintain my co2 levels......My doctor prescribed
after a ER visit.... I was retaining co2, and they hoped to
avoid putting me on the ventilator.
They used a bi-pap and monitored me over night... and they
were successful in stablizing me.
My doctor ordered me one for home and I
have used it ever since. I just love my bi-pap.... couldn't
live without it. I feel soooo
good when I awake... so refreshed. If
I don't feel right, many times I will take a nap with it.
2. I will tell you everything
that I know about a bipap from what my pulmonologist has told
me. Your doctor prescribes it. As
I understand the bipap is 2
level...inspiration and exhalations. You connect your o2
tubing to the bipap.. In a bipap this forces the
airways open and also forces o2 into the
lungs. You get a higher percentage of o2, not sure the exact
figure, but I believe its 2 or
3 % more. This
helps to get rid of co2. There are 2 level settings, which
your doctor orders set when it arrives. Thats about all
I can tell you.
Air pressure in a cpap opens the airways so
one can breathe easier.
3. I didn't have any real problems
adjusting to this, because by that time....I was anxious for
anything that would make me better
When co2 is high.... you lose your ability
to think clearly, and as it climbs........you can imagine......
you continue to lose brain
functions, not to mention, your other
organs, and I wanted to keep my thought processess clear...so I
did what I had tooo.....
The mask fits snugly... on your face,
shaped like the top part of a nebulizer mask, covering the nose,
but sitting on your upper lip.
Its a half mask and does not cover your
mouth. and .......at first you feel like you are
suffocating....especially with the forced air
pressure. Once you get over the
adjustment of having this mask on...and how good you feel....I
think you will love the results...
There are many different types of
masks. They usually give you the standard
mask.. I prefer the headgear with my mask......it
helps me to situate it on my head. It
has four straps...that you can adjust to your preference.
and just this last May.... I asked
my supplier about other masks, and the one
I chose..... has the rim of the mask made of a soft
pliable ???.....almost like playdough...
it feels sooo good to the face...... I am
very, very happy with this one. It feels like nothing there, and
no more crease on the nose. I recommend this one. I will
try to find the name if anyone is interested. It is very
important to find a mask that is comfortable. If it
doesn't sit right, you will lose the
benefit of the bi-pap.
Sophia in Pa SoFreeA@AOL.COM
Hi---
My father uses a bi-pap at night for (at
least in principle) 8 hours, & also during an afternoon nap
of about 3 hours. He says he
sleeps better during the nap. He uses
a mask that covers his mouth as well as his nose because he tends
to breathe through the
mouth when asleep. His pulmonary
problems result from having had TB (& associated surgery) in
1942-46.
The bi-pap seems to have succeeded *most*
of the time, so far, in keeping him from having to be on a
"real" ventilator.
Best wishes,
Dan Smith dwsmith@whoi.edu
I ask anyone to correct me if I am wrong about
anything I say. The only thing I know for sure is that when I can
use my
bi-pap it is wonderful!
I first started on
a c-pap. It is a continuous flow of air and your O2 mixed being
"blown" in. It usually takes a bit of getting
used to, but if yu can take it, you will be
glad you did. The bi-pap not only blows air and your O2 in,
but ,also, helps blow air
out. I never took the time to find out
how or anything (I believe I will now), but I do know
it gives your lungs, and you a
needed break.
I can't use mine
when I have a nose cold or anything that would stuff up my
nose,because you must sleep with your mouth
closed when using these machines. That even
sounds terrible to some people, but if you can at all learn to do
it please try. You
----or maybe I should just stick to my own
experiences---anyway, it makes me feel so refreshed in the
morning and I hardly
ever "nod off" during the day
when using one or the other.
Really, if you can
at all stand it, the little things that you may get used to
anyway, will seem more than worth it.
May good breathing
be with you everywhere you go.
Janice/in janholly@WEBTV.NET
Once I used a Healthdyne Quantum. This
is a fancy Bipap machine. It really is more of a noninvasive
ventilator to be exact. It can be
set to breathe for you if you miss a
breathe. In other words, it can be set to operate on a timed
cycle instead of on demand. But a
bipap can be set for two pressures. One
being the pressure that it has to reach on inhalation. That means
it has to reach a certain
back pressure before in stops input. That
is set to fill out your lungs completely. Then one can set the so
to speak "back pressure"
also. That is the pressure that is
maintained when the machine drops the former pressure when you
exhale. It does this so you can
exhale easily and not fight that former
pressure. This holding of back pressure enables the bronchioles
to remain open and also helps
maintain the soft palate to remain closed.
It acts almost like pursed lipped breathing. The soft palate in
the rear of the mouth is held
shut by this pressure so that no air is
forced out of the mouth. You can open that palate by mindfully
doing so then the air rushes out
of your mouth instead. What a strange
sensation that is!
These machines are only as good as they are
set up for. I had considerable problems getting comfortable with
mine as it was not set
up well. I learned about it and ended up
changing the set points myself until it fit my needs. And
my needs where much higher than
they originally set it up for. That caused
me to fight it all the time. Another problem I had with it was
when I was sleeping, my
respiratory rate fell off considerably. In
doing so, I would not trip the higher intake pressure on the
machine. I would fight that and
get low stats till I would finally gasp and
trip it again. And many times you don't wake up fully when doing
this. Then you wake up
tired. When I caught that happening, I
found that the back pressure setting needed to be set higher to
keep it tripping at those times.
After I corrected that, it was fine.
Another problem with them is the mask. They have to seal over the
nose so that this pressure can
be maintained without leakage. This leads
to a few problems. One being keeping it on and in position during
sleep. The head gear
is interesting when you get it. Ha, ha!
Then there is a problem with chaffing of the nose bridge from it.
If that happens it is very sore
and one will need to stop using it till it
heals. I found that if one changes the way the mask straps are
used, this can be eliminated a
great deal. I would just put the top strap
tension enough so that it just held the mask there. Not tight.
Then the bottom straps I would
make to pull straight back over the ears
instead of at an angle. This enabled me to only need to make it
just tight enough to seal and
no tighter. With the straight pull and less
pressure, the nose did not suffer the chaffing. I used a gel mask
and I think that is what they
all use now. If not, that is what you want
with it. The machine does help a great deal. It keeps the
lungs filled out to get the maximum
surface area in use at all times. Many
times you can cut your 02 back and still maintain your stats well
with it. I could easily. It also
keeps the velocity up in the air ways and
so keeps the fluids and mucus clear at night. It is a pain
to get operating right but can be well
worth the effort in many cases. But it
needs careful set up to get the comfort and best from it.
Gene Downey Gdwny@aol.com
I have had a BiPap since
first put on Ox in '98 but even after three different masks I
still have not been able to use it overnight. I even
went so far as to take the three or four
straps loose and just had one strap around my head (thinking it
would be similar to our paper
face mask or surgical masks) and would not
give me that feeling of being confined or claustrophobic.
But no dice.
I just took it out of the closet the day
before Olivija's post came in and am in the process of having my
supplier come by to make sure
its clean and in working condition so I can
try once again to use it. My SATS have been in the 86 - 88
range for a couple of weeks,
and that after getting my PCP to up my Ox
from 1.5 to 2LPM. I finally purchased a Nonin Oximiter
(pulse ox) (Aeromedix.com)
and my doc said if my ox stayed a
constant 89 or below he would up my Ox to 2. Even with the
2 I am only getting a reading
of 87-88.
"Its the mask, Olivija. The
mask. Beat that and you've got it made."
I ended up taking the BIPAP off and just
wearing O2 from the concentrator. I don't use O2 at night
with the BIPAP because the
air movement gives me a boost enough that I
don't need it.
Native Texan made the two comments above
that seem like a contradiction of some sort. Are you saying
that you just use the
BiPap for the 'pumping' aspect, without
having oxygen coming through?
Why? Even if you say it "gives
you a boost enough that you don't need it", it would seem to
me you would be ahead by using the ox.
I've felt that if I could just tolerate the
mask long enough to take a short nap during the day, or just hold
it on for awhile, it would be a tremendous help to me.
Dick Fugatt rfugatt@NWGA.COM
Hi. This is Sandra
from RI. I have been on Bi-pap for a little over a
year. I had elevated CO2 levels and was having some of the
problems you mentioned. Problrms
concentrating, memory loss, etc.
I had some difficulties in the beginning
because my O2 sat's were still dropping during sleep. It
has been resolved with the addition
of Flovent. I sleep well now. I
feel much more " clear " headed and the memory problem
has gone. (I still have some senior moments though!!
I use the nasal mask and have the humidification. I have
adjusted pretty well to it, my CO2 levels have dropped to the
60's (haven't had blood gases in a while). The best thing
is that I get a good nights sleep.
I hope this helps
Sandynik@aol.com
Respironics,
Respironics Masks, Respironics Sleep Disorder masks, GoldSeal,
TheSleep Center
The absolutely incredible Respiratory CareSource Pages
Worsening respiratory failure
TheBiPAP Ventilatory
Suuport System is designed with
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administered.
DG DISPATCH - ERS: Non-Invasive
Ventilation Linked To Lower Risk Of
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The Sleep Apnea InformationClearinghouse
VENTILATION
AND RESPIRATORY ISSUES RELATING TO NEUROMUSCULAR DISEASES
BiPAP
Pulmonary & Critical Care MedicineEvery Breath You Take
Mallinckrodt Puritan-Bennett Product CatalogueBreeze™
SleepGear™
Here are some helpful hints for making your nasal
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The Custom
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Citations: Noninvasive
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Respiratory Care Education RespironicsBiPAP S/T-D
A BREATH OF FRESH AIR RESPIRATORY
CARE CAN IMPROVE QUALITY OF LIFE
Noninvasive Ventilatory Support: Who
Benefits? More patients
than you might think. Here's how to use it.
RN/MCPHU Home Study Program CE CENTERVentilation
Without Intubation
Effects of CPAP-applicationvia nasal mask and mouth-piece on gas exchange
and respiratory mechanics after cardiac surgery
Nocturnal Nasal Intermittent Positive Pressure
Ventilation (NIPPV) Therapy for chronic
respiratory failure: long term effects
Non-invasive assisted
ventilation (NIPPV/NIAV) in the
management of acute hypercapnic failure secondary to COPD
The results of a pilot study demonstrate that a
"mini tracheostomy" for treatment of severe obstructive sleep apnea may be far
more acceptable to patients
than standard tracheostomy or the use of continuous positive
airway pressure (CPAP).
___________________________________________________________________________________
| Critical
Care Ask The Expert Optimal Modes of Ventilation for
Weaning from Medscape Critical Care QuestionIs it better to use the assisted/control or synchronous intermittent mandatory ventilation (SIMV) with pressure support mode of ventilation in patients who fail weaning? Ahmed Fathy, MD Responsefrom Christine Campbell Reardon, MD, 04/30/2002 There has been much written as to the best way to wean patients from mechanical ventilation. Two large trials have shown that 24% to 29% of patients fail in their first attempt at weaning.[1,2] The "difficult-to-wean" patients fail generally because their underlying illness has not resolved sufficiently to permit liberation from mechanical ventilation. The other major barriers to weaning include malnutrition, excessive secretions, presence of autoPEEP, impaired muscle function secondary to hypokalemia, hypophosphatemia, or hypomagnesemia, or respiratory muscle fatigue. Dysynchrony between the patient and the ventilator can also increase the work of breathing for the patient and can lead to muscle fatigue and weaning failure. Optimizing patient-ventilator synchrony minimizes the individual's work of breathing and allows the patient to receive as much support from the ventilator as possible. It should be noted that respiratory muscles do not completely rest even when a patient is on mechanical ventilation. The inspiratory muscles continue to contract during assisted breaths in IMV, AC, and PS modes. The flow rate, trigger sensitivity, and method of triggering should be assessed as to the adequacy of meeting the patient's ventilatory demand. If the flow setting is too low or the trigger setting not sensitive enough, there will be an increase in the patient's overall work of breathing by making the triggering of inspiration more difficult. Using a flow-triggering mode of ventilation will reduce inspiratory effort 30% to 40% more than pressure triggering during mechanical ventilation.[3,4] Several trials have compared the efficacy of weaning methods.[1,2] One trial found that the length of weaning was shorter with PS than with IMV or spontaneous breathing trial (SBT).[1] In contrast, another trial demonstrated that a spontaneous breathing trial performed once daily resulted in extubation 3 times more quickly than IMV and 2 times as quickly as PS.[2] The studies differ significantly in the criteria used to determine the suitability for extubation. In the first study, the patients weaned by IMV had to tolerate a rate of 4 for 24 hours prior to extubation. In the second study, once patients tolerated IMV of 5 for 2 hours, they were extubated. Similarly for SBTs, in the first study, the physicians could request 3 SBTs for 2 hours each prior to authorizing extubation attempt. In the second trial, if patients tolerated SBT for 2 hours, they were extubated. General recommendations for the difficult-to-wean patient include having patience until the underlying disease process resolves sufficiently; optimizing nutritional and metabolic parameters; maximizing patient-ventilator synchrony to reduce the work of breathing; and providing adequate muscle rest. Once the patient is deemed ready for weaning, daily SBT will likely be the most efficacious method of weaning. The goal of the SBT should be 2 hours without clinical distress. |
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Last edited 5-8-2002