Trilogy 100 settings

[Caregiver]

Hello,
My wife is struggling to use the Trilogy, do these settings look correct.

Mode Avaps-ae
Rate. 5.0cmH20
Tidal volume 390
Max pressure 32.0
Pressure support Max 20.0
Pressure support minimum 4.0
EPAP max pressure 12.0
EPAP min pressure 12.0
Breath rate auto
Trigger rate auto-trac

Any help would greatly appreciated.

[Pugsy]

What is her diagnosis to get her a need to use this type of machine?

[Caregiver]

Copd

[Pugsy]

EPAP max pressure 12.0
EPAP min pressure 12.0

EPAP both min and max are set to 12?? That's a bit odd but maybe they are just wanting to force ventilation.

With PS of 4 that would make IPAP 16.

What problem is she having?

I need to send a note to alert the one person I know who is more familiar with the ins and outs of the Trilogy....it's a different beast entirely.
See if I can get her to drop by this thread.

[Caregiver]

She doesn’t have enough time to exhale before machine pushes more air.

Thanks for your help

[Pugsy]

That doesn't surprise me..it can rush people who don't have copd.
I have sent a note to someone that I know who uses this type of machine and thus is much more educated about the ins and outs of this model machine and asked her to stop by here and see if she has some ideas.
We don't have very forum members here familiar with this type of machine at all.
I am not sure what might be available to lengthen the time between exhale and inhale to maybe give her a little more ease with a COPD diagnosis.

[Pugsy]

It will be tomorrow before the person I know will be able to respond...so be sure to check back tomorrow.

In the meantime...how long has she been using this machine and have you told her doctor about the difficulties with the timing of the exhale/inhale response?

[Madalot]

She doesn’t have enough time to exhale before machine pushes more air.

Thanks for your help

I know nothing about COPD, but I do use the Trilogy 100 for a different situation. I use regular AVAPS, finding the AE uncomfortable. And one thing I would like to mention that using the AVAPS-AE with the Min/Max EPAP the same, makes no sense to me.

But as to your wife not completing an exhale before an inhale has pushed on her, been there, done that! I would start with the Breath Rate (I think it is on Auto) and maybe set it lower to a SET rate instead of letting the machine do it.

Also, there is a setting for Inspiratory Time which might help.

**DISCLAIMER** - Like I said, I know nothing about COPD so any changes should be run by a medical professional.

[Caregiver]

Madalot,

Thanks so much for your reply. From what I understand the EPAP min should be much lower say around 4.
Does that sound about right to you.

[Pugsy]

From what I understand the EPAP min should be much lower say around 4.
Does that sound about right to you.

Why do you think 4 cm for EPAP?

[Madalot]

Madalot,

Thanks so much for your reply. From what I understand the EPAP min should be much lower say around 4.
Does that sound about right to you.

Well, an EPAP of 4 sounds too low to me.

But here's the thing. AVAPS with AE means "Auto EPAP." By having the EPAP Min/Max the same, using the AE option is a little silly. There needs to be a range.

I stopped using AE because a set EPAP (mine is 10) is easier for me. The algorithm used for AVAPS-AE is an FOT, which sends pulses to test the airway. Those pulses badly disturbed my sleep.

I would definitely run this by a professional, though.

[Pugsy]

Well, an EPAP of 4 sounds too low to me.

yeah, me too.
Especially if the Trilogy is just being use to ventilate. EPAP of 4 with PS of 4 isn't going to move much air and my not be able to achieve desired volume.
With only COPD being involved (and not tradition OSA stuff) the reasoning may be more for target volume of air movement and not holding the airway open per se.

If it is just target volume there may not be a need for an EPAP range in this situation which might explain the Min/Max EPAP setting.
They are only wanting to ventilate adequately and fixed settings might just be all that is needed.

I am thinking that the timing of the inhale/exhale (at whatever settings) is going to be the most help and maybe the medical care team could maybe play with the Inspiratory Time thing and maybe the breath rate to achieve the comfort needed in this situation. It's what I would ask them to do if this were a family member of mine long before I would start messing with EPAP itself given the diagnosis.

[Madalot]

I am thinking that the timing of the inhale/exhale (at whatever settings) is going to be the most help and maybe the medical care team could maybe play with the Inspiratory Time thing and maybe the breath rate to achieve the comfort needed in this situation. It's what I would ask them to do if this were a family member of mine long before I would start messing with EPAP itself given the diagnosis.

I agree with you, Pugsy. If this were me, that's where I would start as well. Although I might ask them why the AVAPS-AE but have the EPAP Min/Max the same.

[ajack]

EDIT....one obvious thing I missed is if she is new to machines,,, you feel like you don't fully breathe out, because of the base or epap pressure holding the lung open. The machine may be set up perfectly and it's just this.


If she doesn't have apnea, she may not need an adjustable epap? More than likely, the titration study, decided that was the best, to have a fixed pressure.
My thoughts are to get you over the holidays till you can see your doctor. If in doubt or the breathing is laboured, I would go to hospital.

If she is having trouble with the time needed to breathe out, that could be in the rise time and Ti settings. It also could be a sensitive trigger setting that is picking up an oscillation on exhale that it thinks is a start of inhale. or it could be the auto backup deciding that the time is up. I would leave the pressure settings alone for now, I can't see that as being the issue.

I would first look at trigger settings, I forget if 1 is sensitive end and 7 is slower end of adjustment. Madalot will know, she adjusted her sensitivity not long ago. I'd experiment while she is awake and get it comfortable, so it isn't self triggering nor does it feel like she has to suck hard for it to trigger. adjust it one number and see how it feels

if the auto backup isn't doing it right and making a breath when not needed, a manual rate can be used with doctor approval, 10 is common, but at least 2 below the breathing rate. Did she have Central apnea where she stopped breathing, or slowed breathing rate with the copd? Os is it just auto breaths as a default setting?

I doubt they would have got the Ti and rise time settings wrong and is taking too much time on the inhale, With copd you want a quick inhale to give time to breathe out. generally, the rise time is 150, how quickly it rises to the treatment pressure and the Ti is between 0.7 and 1.7 depending on respiration rate. how long the inhalation breath can last for. page 24 and surrounding pages
https://www.scribd.com/document/3534028 ... -Titration

[Julie]

Just a note - nothing is holding the lungs open, just the airway.