How to change Bipap settings as for the disease progress?

[iniran]

Dear PALS, hope you the bests.
I started Bipap 1 year ago for my patient with below settings:
mode: ST
IPAP: 12.0
EPAP: 5.0
IBR: on
Target pt Rate: 14
Trigger: high (i dont know what is this)
Cycle: Med (i dont know what is this)
Ti max: 2.0 sec (i dont know what is this)
Ti min: 0.3 sec (i dont know what is this)
rise time 250 ms




sleep report:
MV: 7.0 L/min
TI : 1.2 s
I:E 1:2.3
spont trig: 16%
spont cyc: 85%
AHI: 0.0
Total: AI 0.0
vt: 460ml
RR: 15
MV 7.0 L/min
Leak 14 L/min
Exp. pressure 4.9
pressure 14.4



during the past several months, I gradually increased the IPAP to 14.6 (my patient felt shortness of breath and after this change, he felt better).

My device is Resmed.

now my patient has breathing difficulty again, and I am not sure if any further increase in IPAP will be helpful or dangerous?

I can not paraphrase the results of MV, RR, VT,TI, I:E.

could anyone please help me if the numbers are ok for an ALS patient who has almost completely disabled?

 

[lgelb]

Dear Iniran,

I will PM you so we can correspond via email. The first thing I would do is reduce target rate from 14 to 8. Before suggesting anything else, I will ask for the patient's gender, height, weight, mask type, and any smoking history or other lung issues, and will have some questions for the patient as well.

Best,
Laurie

 

[iniran]

Dear Laurie
I'm really grateful for your response.
As your advice, I changed the target rate to 8, unfortunately, after a half of a day, the patient felt unwell and I had to turn it back to 14.
I dont know what to do now.
The device settings are attached.

Thank you for your time and consideration
best regards

 

[iniran]

Dear Laurie
I'm really grateful for your response.
As your advice, I changed the target rate to 8, unfortunately, after a half of a day, the patient felt unwell and I had to turn it back to 14.
According to the device report, when the rate was 8, 100% of the respirations were spontaneously, but when it comes to 14, 85% of them are spontaneous.


I dont know what to do now.
The device settings are attached.

The patient is a male, 60 years old,heigh 180, weight before ALS: 73kg, now about 45 kg, with no smoking history or other lung issues.
completely disabled, cannot breathe without bipap (only for 5-10 minutes thorough nose oxygen mask), his mask is a full face (nose and mouth), he is using bipap for about 8 years, now about 23 hours a day.
He is fed by PEG.


Thank you for your time and consideration
best regards

 

[lgelb]

I am writing you a separate email, Masood, based on the information you sent me.