Trilogy pressure drop

[Coachcj]

I could really use help with this. So Thank you in advance for your time and knowledge.

My mother is 81 and was working just prior to the start of the pandemic as a bookeeper couple times a week for her church. So she was pretty cognitively "with it" up to that point. I'll just list the timeline to make it easier to follow.

1. she has had long term Interstitial lung disease, scoliosis which effects one lungs capacity,
2. she is very rapid breather and "pants"
3. she is a retainer of co2

medical treatments
1. after a bout of pneumonia back in march, she was place on a trilogy vent
2. we would do nebulizer treatments for before putting her on the trilogy
3. she is intolerant of sleeping with the mask, ( some psychological issues with anxiety )
4. when we first started the trilogy in avaps it would deliver 17cm of pressure, the machine began only delivering 10 cm recently this does not get her lungs expanded and trigger her to exhale quicker. her bpm could be in the 60s easily with out the added pressure
5.res ther had dropped machine and I didn't hear from them until her next pulmon appointment, when her pulmonologist ask what the res ther said. he was upset that she was not checking up.
6. res ther tells me the machine is fine and leave it to do it job.
7.res ther swaps out machine bc I insist
8. new machine starts right up at a higher pressure and helps slow down breathing with deeper breaths. cognitive abilities improve.
9. 1 week with the new machine pressure drops back down to 10 cm and cognitive issues increase bpm increases.

pulmo differs to res ther, res ther differs to pulmo. I send videos of the new machines pressure on high and separate when it recalibrate to lower (epap?) pressure. I am thinking she needs to have a set pressure?

[Julie]

Apart from 1-2 members here over a few years, the Trilogy is not something most of us know much about, and I don't know of any who'd know about it in relation to the Avaps... hopefully someone will see your 'Subject" and respond, whether or not they can advise meaningfully. Is her MD/pulmonologist not helpful? I would listen to him/her before the therapist.

[Coachcj]

Thank you. They keep bouncing me back and forth saying the other should address the issue

[raisedfist]

What mode of ventilation is the Trilogy set to? If the AVAPS feature is enabled, the IPAP is variable between the set IPAP min and IPAP max, in order to achieve an average targeted tidal volume that is also set.

The Trilogy also uses a calculation to determine where the IPAP begins when you turn it on, when the AVAPS feature is applied. It takes the higher of IPAP min, EPAP + 8cmh2o, or Vt/360.

If she wants one higher set IPAP, talk to her physician about using the S/T or PC mode of ventilation without the AVAPS feature enabled. Or, the IPAP min with AVAPS could be increased.

The IPAP could be averaging lower because she is no longer acutely ill, and lung compliance could have improved somewhat since then. As patient effort increases, support usually decreases because the targeted Vt is being achieved at a lower pressure.

If you know how, going into and telling us the mode and pressure settings would be helpful.

Also, is an external humidifier and/or in-line outlet bacterial filter attached?

I own a Trilogy and am generally familiar with most of the settings and modes.

[Madalot]

Following. Waiting on more information as has already been requested. I use a Trilogy 100 every night in AVAPS.