Severe chest injury and CPAP?

[kteague]

Wondering if anyone has had experience with this. A close family member was in a near fatal auto accident with a long list of injuries, among which are rib fractures and a fractured sternum. Three surgeries in as many days. He has his CPAP at the hospital because his oxygen kept dropping, but after days of repeated trys he says he simply can't tolerate using it. He's not avoiding using it - he sent for it because he wanted to use it. He says something about his chest is making it intolerable. Wondering if it is simply the pain, or if there's something about the internal pressures (hydraulics?) that changes after blunt force trauma to the chest. He was thinking someone there must have increased his pressure, but they haven't. I'm wondering if I should suggest adding exhale relief to see if that would help. Anybody been down this route? I couldn't get close enough to read the writing on his machine (too much equipment around him) but it is a ResMed with the two silver side by side units. Will try to find out more when I get back to the hospital.

[Julie]

This is something that absoiutely must be discussed with a pulmonologist (or resp. therapist in hosp) at the hospital. We (you) don't know the particulars of his condition apart from his interpretation of what a doctor told him and he should not be left to deal with the Cpap etc. on his own... terrible... and I wonder if the doctors realize what's happening. You and we should not begin to be involved, certainly not yet, and someone should talk to his doctor(s) if he isn't.

[chunkyfrog]

Pain will have that effect. It should get better as he recovers.
If there were any danger from the cpap, the doctor would not allow him to use it.

[Julie]

I disagree... we already know that too many doctors don't fully understand cpap, and don't know if his doctor is e.g. primarily an orthopedic one, or what, and I would want to talk to either that doctor or whatever other ones might be involved before advising anything for a patient like that at this time.

[Wulfman...]

Sorry to hear about your family member.

I would think that if he's breathing somewhat "normally", the pressure on the machine could be adjusted downward until there may be no pain and in conjunction with using exhale relief ( EPR or Flex ). Just enough pressure to be of some assistance.
Then, they could incorporate the oxygen into his mask.


Den

.

[kteague]

He did have added oxygen as he was trying to use the machine. The nurses know zilch about CPAP. He's getting breathing treatments so I'm thinking he must have been seen by a respiratory therapist. Up till now the hospital has been focused on saving his life and managing the damage. As he has stabilized the first couple days, the CPAP was added back into the equation. At first he was afraid the CPAP mask might affect his facial injuries, but it didn't seem to. The fact that he didn't describe it as pain but as feeling as if he couldn't manage the pressure makes me wonder if the sternum not being intact and the blunt force trauma that would surely affect his diaphragm too means he simply can't push air out against the pressure. As it is, his breathing is rapid and shallow. I'd never consider touching the machine of someone in the trauma unit, but am not opposed to suggesting to the staff some specific questions to ask the doctor about (less pressure, epr). Just wish someone there with a clue could answer his questions. Even with exhalation relief or lowered pressure, it may just be more than he can do right now. Today they took him off of oxygen and off the oxygen monitor. How in the dickens do you know someone who already couldn't keep his oxygen up now sees he can't use his CPAP and then you don't even monitor him? This hospital has been phenomenal in saving his very fragile life. Having a hard time reconciling that with their inability to have an informed discussion with him about CPAP. Sorry. Just feeling the stress. And the need to do something tangible and helpful instead of feeling so helpless. Thanks for your replies.

[greatunclebill]

i would leave it alone. it is between a doctor and patient. the doc may know that the cpap will be a tremendous struggle, but is gauging how he is doing medically by how much he can and can't do on the machine. i know you mean well, but also could interfere with what the doc is trying to accomplish. if anything, discuss your feelings with the doc, not the nurses or techs. this is not an argument with you' but rather an opinion by someone not directly involved. Good luck.

[ajack]

It sounds like they are trying to keep his cpap, (peep ,min press, epap) high enough to keep his airways/alveolar inflated and keep his o2 up. It will hurt with a lung and chest injury, get him to talk with the dr about more meds. If he was real bad they would induce a coma and intubate him.

[Julie]

I also wonder about any kind of meaningful 'help' cpap can give if he's e.g. drifting off (and ? half-waking) all day and night... too many things to address from 'here' or even outside of the unit.

[Matt00926]

Chest wall trauma sounds like a good candidate for BiPAP...if the pain causes an inadequate breathing pattern, probably from not being able to take full deep breaths, it would mean ventilation is being effected. Pressure Support is what will augment ventilation, not CPAP. BiPAP also allows the EPAP/CPAP level to be much lower making it easier to breathe out against.

He definitely needs to press the physicians taking care of him for more information/assistance.

[chunkyfrog]

Often respiratory therapy in the hospital is limited to preventing the lungs from collecting fluid.
Your relative may need to get a referral to a respiratory DOCTOR.

[Pugsy]

I have been down the chest injury road...8 broken ribs and a collapsed lung.
It was pre cpap therapy though but I remember the general difficulty breathing and can imagine the extra discomfort exhaling against the pressure.

If it were me I would explore exhale relief opportunities first. Might just be enough to get through the tough times.
If that didn't work then I would consider reducing the pressure itself a bit..some therapy is better than no therapy type of thing.
Or see if the doctor will prescribe a bilevel device where the exhale relief can be higher than what cpap/apap machines offer.

[Janknitz]

I think he needs to see a pulmonologist. The lungs are likely contused and it just seems like there are a lot of variables going on. He may need bipap or some other setting for the time being.

[kteague]

Hi again. Still living out of state with family members who are working at recovering from some tough injuries. The one trying to use CPAP used it a few more nights but the ribcage pain caused him to stop. His chest injuries have improved, but still affect him. He was using oxygen to sleep at the nursing facility but he was not discharged with it. His pressure range is set at 7-11 and EPR is already at 3. Him not being able to exhale against those pressures tells me he's pretty compromised. He says at some point he may try a lower the pressure and see if he can tolerate the treatment, but for now he's got bigger fish to fry, like managing life in a wheelchair with transfers while protecting all the surgery sites on his body that could be seriously damaged by one wrong move. That would be even more difficult to accomplish with more painful ribs. In 6 more weeks he will be able to relax a bit about that and relearn to use his "reinforced" limbs. Thanks everyone for your input. I had decided to back off. He is very much in his right mind and able to make informed decisions, and is quite in tune with his body.

[ajack]

It may just be new user, not feeling like he's breathing out, may just be the exhale pressure keeping the lung inflated a bit and is normal, google peep, alveolar recruitment lung injury
https://www.google.com.au/search?q=peep ... e&ie=UTF-8

tell him not to try to breathe out, just let it happen, he is getting plenty of air, you can even use sleepyhead to show him the tidal volume.