What is a Tracheostomy Tube.
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- Опубликовано: 22 июн 2024
- A tracheostomy tube is a medical device which acts as an artificial airway. It is inserted directly into the trachea through a surgically created hole call a stoma. Tracheostomy tubes come sin many different shapes and sizes. #lifewithavent #trach #shorts
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Hello there!
I just wanted to give you a quick update (if you remember) and ask for some more advice please!
So I ended up getting a trach (again) for my sleep apnea with a bigger tube, hoping that this would be it.
But I still had trouble with my sleep so I thought maybe getting a bipap would help me breathe better during sleep.
But that didn't help either, as I felt myself losing my respiratory drive (not too sure of the reason) as my body relaxes, sort of like a central SA. Until it completely loses it, then wake up hyperventilating to make up for the loss oxygen and the cycle continues throughout the night.
Anyways, I was deciding whether to get a ASV or a Bipap ST which both have "timed" modes so that essentially it would "breathe" for me during my sleep like a ventilator.
I got an ASV first but was disappointed to see that I didn't have much control on it. I couldn't set Ipap, nor could raise the PS above 6 nor set my respiratory rate.
The lack of control and power didn't improve my SA.
So I decided to get a ST, but even though it had much more settings to control, I couldn't fall asleep and stay asleep with it.
I'm guessing the main reason for that is that the Bipap ST had adjustable "rise time" for a smoother inhalation but lacked "fall time" for exhalation which led to unnatural abrupt exhalation.
I thought I would just get used to it but I think it's crucial that I need to address this issue.
I've done some research and i think Stellar 150 has that "fall time" setting where I can adjust the speed from IPAP to EPAP, which would smooth the exhalation a bit, leading to a more comfortable, natural exhalation.
However, I couldn't find much information on this online, not even with the higher models like Astral and Trilogy. I'm wondering what your experiences are with the comfortability of the breathing with the ventilators you're using. Do these top models already have this preset in their systems?
I could only find the "fall time" only for Stellar 150. I think something similar would be "easy breathe" for other resmed models like ASV, which I did find more natural and comfortable but too weak and un-adjustable. After a long research, I think it's called "flow shape" in Astral...do all ventilators have something similar to that?
I also find breathing thru the tube to be very stuffy and less "fresh" which I suppose is to be expected but is there way to improve that? I just always feel like I'm suffocating a lil bit. I don't thin lower temp and humidity makes much of a positive difference, just itches my throat a bit more.
Would you suggest that Stellar 150 with timed and "fall time" would be the machine to finally give me some rest? or should I pursue a higher machine?
Thank you for your time and expertise again!
Thank you for the update. I am not sure if the Stellar 150 would be useful or not. I am not familiar with BiPAP or ASV settings. I use the AC mode on my machine. The only settings in the AC mode which can be adjusted are the tidal volume, breath rate, inspiratory time, flow pattern, trigger type and PEEP.
Perhaps this article may help you find the information you are looking for. Article summary: "While much attention has focused on the inspiratory phase, the purpose of this report is to examine the cycling and expiratory phase of the mechanical ventilator breath. Other important topics include premature cycling, delayed cycling, and the ramifications of expiratory asynchrony."
Here is the link to the article if you wish to read it: rc.rcjournal.com/content/56/1/52
@@LifewithaVent it might be "flow pattern" that im thinking of. What model are you using?
Are the breaths natural, comfortable and "wavy"? Not abrupt when inhalation moves to exhalation?
I couldn't fall asleep with Bipap bc the jump from ipap to epap was too abrupt, Im surprised not much info is out there for this
Thank you again!
Hello. Here are some things I forgot to address in my last comment.
Stale air: This might be from the ventilator. Whenever I get a ventilator, I allow the ventilator to run for 1-2 days outside to get rid of any dust or smells which may be in the machine. One machine I had to run for 7 days to get rid of the smell.
Regarding the abrupt exhalation: It is not flow pattern.
Flow pattern is the pattern in which the flow of air is given. There are two basic patterns. First, the machine can give a strong blast for the inhalation and sustains this pressure for a certain timeframe. Once the inhalation part of the cycle is over, it abruptly drops the pressure. This is called the square flow pattern. It is used for people with COPD.
The second flow pattern is called ramp. It gradually gives the inhalation until it reaches the desired pressure or volume over a certain timeframe, it then drops the pressure to allow for exhalation. Ramp flow pattern is used for most people.
Continuing on, there are two general forms of ventilation. They are pressure support and volume support. BiPAP (S, T, S/T) and ASV are pressure support ventilation. Pressure support ventilation only cares about the pressures which are being delivered. The patient is responsible to get the proper volume of air during ventilation.
Pressure support ventilation works as follows: preset pressures are programmed into the device. The machine gives the appropriate pressure for inhalation and then drops the pressure to the exhalation pressure. The volume of air is not taken into account. The person is responsible to adjust his breathing to get the proper amount of air into his lungs.
Volume support ventilation has a preset volume the machine needs to give. The machine makes constant calculations (based on the amount of air exhaled) how much volume the person is receiving. The pressures the machine delivers are constantly adjusted to make sure the person is always receiving the same volume of air.
There are modes called AVAPS and iVAPS which are technically pressure support ventilation, but they also taken into account the volume of the air being delivered. In these modes, a range of preset pressures are entered into the device. It is called IPAP minimum and IPAP maximum. Also, a preset tidal volume is entered. The machine calculates the amount of pressure needed to deliver the tidal volume. The pressure delivered will only be within the minimum IPAP and maximum IPAP.
Please note, some machines such as the Trilogy can incorporate AVAPS into the S, T, and S/T modes. There is also another mode called AVAPS-AE and iVAPS with auto-EPAP. This is an even more advanced setting in which the EPAP is also adjusted.
Based on what you have told me, it seems you have only tried BiPAP in the S and S/T mode and also ASV. I do not believe you have tried AVAPS, iVAPS, AVAPS-AE or iVAPS with auto-EPE. These may be a better option for you. It might be worthwhile to look into these other modes. (Due to the length of this message, I am going to start another comment.)
I will copy down the options available for the S, S/T and AVAPS-AE on the Trilogy. This will hopefully help you decide if the Trilogy may or may not be the right machine for you.
S mode
IPAP, EPAP, Trigger Type, Flow trigger sensitivity, flow cycle sensitivity, rise time, ramp length. It also has the ability to incorporate AVAPS into the setting. If incorporating AVAPS into the S mode, there are additional parameters such as AVAPS rate, tidal volume, IPAP max pressure and IPAP min pressure
S/T mode
IPAP, EPAP, breath rate, inspiratory time, trigger type, flow trigger sensitivity, flow cycle sensitivity, rise time and ramp length. It also has the ability to incorporate AVAPS into the setting. If incorporating AVAPS into the S/T mode, there are additional parameters such as AVAPS rate, tidal volume, IPAP max pressure and IPAP min pressure
AVAPS-AE mode
AVAPS rate, tidal volume, maximum pressure, pressure support maximum, pressure support minimum, EPAP max pressure, EPAP minimum pressure, breathe rate, trigger type, flow trigger sensitivity, flow cycle sensitivity, rise time, and ramp length
I am using a Trilogy 100. The way my machine works is it gives me a slow steady inhalation until the tidal volume is reached. Once the tidal volume is reached, the pressure is cut off and drops down to the PEEP. (PEEP is positive end expiatory pressure. This pressure is need to prevent the lungs from collapsing.) For me, the pressure during inspiration reaches a peak inspiratory pressure of about 10 cm H20 in 1.7 seconds. During this time, the tidal volume of 500 mL of air is delivered. After 1.7 seconds, the machine drops the pressure down to 5 cm H2O. It does this abruptly to allow my lungs to naturally exhale. It feels normal to me. I have never had any issues with it.