Just started using Astral-100 & the breathlessness is back (?)

[milton939]

My mom has been using a Bipap device, fr last 2 weeks, after her tracheostomy. The docs had her switched to Astral-100, 2 days back, as it was more suitable for her.

But she has been feeling breathless/ heaviness in chest, often in the evening, after switching. Initially she said she was feeling better, felt less secretions in the throat. But now she complains that the cough in her chest has become hardened. Suctioning her multiple times had very lil result & the problem persists till midnight till she fells asleep. Doc's have prescribe expectorants for the cough, 2 days back, but not much use.

Her SPO2 reading using the pulse was above 90% most of the time. The ventilator had raised "Obstruction" alarm some times. And some times, it was normal but the problem persists, as she felt. We could hear very low sound of expiratory air through her ventilation tube, which was much higher earlier when her breathing was OK.

The Astral-100 is running on P(A)CV mode now. I'm curious if it is OK for her, or we need to switch it to some other mode. Or any other remedy is required ? Unfortunately, the pulmonologist here have very lil knowledge/ experience about functioning of these devices. They rely on the knowledge of the vendors ( which I suspect to be unreliable, as they operate in commercial interest).

Can anyone here suggest me on what to do?

 

[KimT]

Milton,
I defer to Laurie on this one. She probably has a suggestion.

 

[lgelb]

The Astral 150 would be a better machine for her, as it can measure her expiration output and give her more flexibility in the types of breaths she takes. However, if the 150 is not possible to obtain, it may well be possible for her to be comfortable with the 100. I don't think it's being in PACV mode that's the problem, exactly, but it may well be elsewhere in the settings.

To start, I would check that the machine has a humidifier and it is being kept filled with water. Then I would ask for a copy of her settings, including the ventilation mode, when she was on the other machine, and what they are now. If you can post or PM those, I could be more helpful.

Also, can you look at the screen at see what her breathing looks like in terms of the numbers on the screen? Do you have a clinical manual? I am posting one here.

Best,
Laurie

 

[milton939]

Hi Laurie,
The ventilator was set to PSSV mode initially by the supplier. Later they suggested that PACV was appropriate.

After that, we moved back to home, from the hospital & consulted a pulmonologist, who lives nearby. This doctor knows a good deal about ventilators & suggested V-SIMV mode, which is now active. Mom Seems to have been able to adjust well with the new

ABG test report, before using ventilator:

Electrolytes test report (before using ventilator):

Present monitoring screen

settings screen

 

[lgelb]

Hi Milton,
Yes, she is clearly doing better with V-SIMV. In fact, her RSBI suggests that she might be able to be weaned from the ventilator such that she could do more of the breathing on her own, with support, in time. You might discuss with the pulmonologist, and also ask if the PEEP could be reduced because it looks like when she tries to breathe on her own, she is having difficulty breathing against it.

Best,
Laurie

 

[milton939]

Laurie,
Thanks for the good news ! I showed ur reply to my sis & we both were excited !

We have created a mini hospital like environment home with patient bed, nebulizer, suction machine etc and related surgical/medical stuff. 2 ICU experienced nurses attend her round the clock. We also called a Chest-physio to visit us & provide advice on how to improve her lungs. He also said it's possible with time & effort. Advised us some chest related physiotherapy.

Her main complication is now coughing. She coughs a lot & gets exhausted, mainly during 5 PM to 10 PM. Her body seems to be getting weak, & may be loosing weight a lil. The pulmonologist advised for nebulization 7 times a day
( Salbutamol, acetylcysteine ) to keep her airway clear, as its getting clogged by mucus / cough. I guess if coughing gets minimized, she will feel better, and can sit on her own, allowing us more scope to work with her lungs.

Thanks again for your help.

 

[milton939]

Can vent mode settings create breathlessness / chest pain ?

Few days back doc changed the vent mode to ACV from V-SIMV.
For last 2-3 days she is complaining about chest pain / breathlessness. Although her stats are very normal:

SPO2 : 90~98, Pulse: 88-110, BP: 120/90, usually low

Repeated Suctions are not yielding much result. Sometimes, a lil blood is coming.

Her muscles are getting weak. Pathological tests saying that, electrolytes are kinda low.

Any suggestions Laurie ?

 

[lgelb]

I would revert to the last settings/mode at which she was comfortable, reconsider hydration, heated room humidification and temporarily reducing the number of neb treatments which can be exhausting in their own right, to make suction more productive if possible. I'm not clear on why she was switched back to ACV if she was stable on SIMV-V. As for the 'lytes, nutrition is very important so supplementing formula or looking at alternative brands are possible approaches.