Trach vs mask for sleeping with vent. When?

A little off topic I know and I'll welcome any pointers to more appropriate sources if any. I'm trying to get a handle on a friend's situation so I don't have all the details. In fact I think I need a lot more information to even know what details I don't have. Nonetheless I'd appreciate any insights people may have on when moving to a trach and ventilator from bipap with mask is necessary. Apnea is involved but isn't the only breathing problem - possibly not the main one. Are there other reasons to need a ventilator connected to a trach tube other than obstructive apnea?

Any insights or remedial reading suggestions welcome.

Midnightowl

PS. I have garden variety apnea myself and have been hanglng around here for several years even thought I rarely post so you can assume some knowledge of the mechanics of (garden variety) apnea but not that much about respiratory issues in general.

Usually there is another condition involved to cause someone to need invasive ventilation (tracheostomy) versus noninvasive ventilation (mask). It could be some type of respiratory failure due to copd, a neuromuscular disease like ALS or Guillian Barre, or a restrictive lung disorder like pulmonary fibrosis. They will probably require a blood gas to be drawn to make sure the patient is not expelling carbon dioxide normally (a common sign of COPD). The ventilator will give a set volume of air to ensure that the person is adequately ventilated where most bipaps just push air in until the patient initiates an exhalation. Hope that halfway answers your question. If not, let me know and I can find you some more in depth info.
Kevin

kevincoop wrote:They will probably require a blood gas to be drawn to make sure the patient is not expelling carbon dioxide normally (a common sign of COPD). The ventilator will give a set volume of air to ensure that the person is adequately ventilated where most bipaps just push air in until the patient initiates an exhalation. Hope that halfway answers your question. If not, let me know and I can find you some more in depth info.

They did and weren't so you've answered a lot. Is there a reason that set volume of air can't be delivered thru a mask as easily as thru a trach tube?

you may want to read some of what Madalot's going through... she's moved to a vent.

Usually the trach is placed to bypass the obstruction in the airway, or clear secretions. The main reason is reliability. The pressure can be delivered by a mask but not as efficiently. You will get leaks and your friend may need to use this during the day too. It would be very uncomfortable to use the mask 24 hours a day. Some people can get a trach plug so they can use a mask sometimes or if the trach is temporary to get used to going to a mask. It sounds like with the condition though it won't be temporary.
Wish your friend luck,
Kevin

cflame1 wrote:you may want to read some of what Madalot's going through... she's moved to a vent.

Thanks. I've been reading her posts with great interest.

kevincoop wrote:The pressure can be delivered by a mask but not as efficiently. You will get leaks and your friend may need to use this during the day too. It would be very uncomfortable to use the mask 24 hours a day.

Kevin,
It's not temporary but it's also not 24 hrs - at least not yet. I really appreciate the answers you've given and I'm going to keep imposing on your patience a bit longer. Would a ventilator be more vulnerable to leaks than a bipap? How does the decision normally get made to go from a mask to a trach tube? Are there guidelines? Is this a matter of provider preference?

Owl.

No they are probably about the same on leaks. Vents do try to push a certain volume or pressure before switching to exhalation so they may leak at peak pressures. The vent will just give you a visual or alarm immediately when the leak is occuring so you can adjust it. I know xpaps can do that too, but these are a little more sophisticated. When you throw it on a trach, you should eliminate most leaks unless the cuff is not inflated entirely.
The mask to trach tube is entirely by physician. If they notice the obstruction not being taken care of with bipap or excessive secretions that cannot be coughed up etc, they may decide to switch. Also if there is a real possibility that the patient will need vent care long term and move to needing it more and more they may go ahead and put one in so the patient can get used to it although they try to make it almost a last resort just because most people hate the time they take to clean and infection is more likely and most patients don't like the stigma attached to having a hole cut in their throat.
Not wanting to paint a dire picture about the long term thing, but with copd that is usually the case. But the trach can vastly improve the person's condition. They do take alot of work, but if someone needs it, they can get the benefit without the discomfort of masks, nasal drying, mask leaks etc.
Google respironics trilogy. This is the newest vent we use for noninvasive and invasive patients.
Kevin

kevincoop wrote:No they are probably about the same on leaks. Vents do try to push a certain volume or pressure before switching to exhalation so they may leak at peak pressures. The vent will just give you a visual or alarm immediately when the leak is occuring so you can adjust it. I know xpaps can do that too, but these are a little more sophisticated. When you throw it on a trach, you should eliminate most leaks unless the cuff is not inflated entirely.
The mask to trach tube is entirely by physician. If they notice the obstruction not being taken care of with bipap or excessive secretions that cannot be coughed up etc, they may decide to switch. Also if there is a real possibility that the patient will need vent care long term and move to needing it more and more they may go ahead and put one in so the patient can get used to it although they try to make it almost a last resort just because most people hate the time they take to clean and infection is more likely and most patients don't like the stigma attached to having a hole cut in their throat.
Not wanting to paint a dire picture about the long term thing, but with copd that is usually the case. But the trach can vastly improve the person's condition. They do take alot of work, but if someone needs it, they can get the benefit without the discomfort of masks, nasal drying, mask leaks etc.
Google respironics trilogy. This is the newest vent we use for noninvasive and invasive patients.
Kevin

I just happened upon this thread this morning. I am using the Trilogy vent right now with a full face mask. I'm interested in Kevin's information also, for obvious reasons. I'd also be happy to answer any questions I can about what's going on with me and how we arrived at where we are.

To the OP -- do you know what condition your friend has that is making a ventilator necessary? If you posted that specifically, I missed it and apologize in advance for asking you to repeat.

Madalot,
It's progressive muscular weakness. Sorry I can't be much more specific. Your posts have been very useful to me so far and I'll happily read as much or as little as you choose to post here.

Midnightowl

kevincoop wrote: The mask to trach tube is entirely by physician. If they notice the obstruction not being taken care of with bipap or excessive secretions that cannot be coughed up etc, they may decide to switch. Also if there is a real possibility that the patient will need vent care long term and move to needing it more and more they may go ahead and put one in so the patient can get used to it although they try to make it almost a last resort just because most people hate the time they take to clean and infection is more likely and most patients don't like the stigma attached to having a hole cut in their throat.
Not wanting to paint a dire picture about the long term thing, but with copd that is usually the case. But the trach can vastly improve the person's condition. They do take alot of work, but if someone needs it, they can get the benefit without the discomfort of masks, nasal drying, mask leaks etc.
Google respironics trilogy. This is the newest vent we use for noninvasive and invasive patients.

Thank you. Reading about the Trilogy will need to wait until tomorrow.

More maintenance time and especially the higher risk of infection seems like a poor trade off for potential discomfort from a mask and possible leaks. Adding in to the mix that vents with trach tubes are unwelcome in many nursing homes seems to me to make this an absolutely last resort for when obstructions can't be cleared any other way. Am I missing something here?

MidnightOwl wrote:Madalot,
It's progressive muscular weakness. Sorry I can't be much more specific. Your posts have been very useful to me so far and I'll happily read as much or as little as you choose to post here.

Midnightowl

That's fine. You don't need to share any more than that. I'm glad that my posts can help someone here. That's one of the things that has prompted me to keep posting -- in the hopes that there might be someone else that can directly benefit from some of my experiences.

Another thing to let you know is that I have found the information available on the Trilogy sparse at best. Since I have one AND have the manual, please feel free to ask any questions about the device and its usage. I'll try to help as best I can.

I agree if it is not absolutely necessary. Most patients who have a trach cannot afford to have any leak. If so, thy will not get adequately ventilated because of their condition. If your friends progressive muscle weakness is due to a neuromuscular disease, those are usually progressive like Lou Geherigs/ALS. Your friends doctor may think the BiPAP is working now, but knows that they will need something to make sure they are getting a deep enough breath later on when the disease progresses.

MidnightOwl wrote:A little off topic I know and I'll welcome any pointers to more appropriate sources if any. I'm trying to get a handle on a friend's situation so I don't have all the details. In fact I think I need a lot more information to even know what details I don't have. Nonetheless I'd appreciate any insights people may have on when moving to a trach and ventilator from bipap with mask is necessary.

I'm not a medical doctor, but my guess is that you move to a trach when that is the ONLY possible solution. Your friend should follow his or her doctor's advice on the matter.

Midnightowl[/quote]

That's fine. You don't need to share any more than that. I'm glad that my posts can help someone here. That's one of the things that has prompted me to keep posting -- in the hopes that there might be someone else that can directly benefit from some of my experiences.

Another thing to let you know is that I have found the information available on the Trilogy sparse at best. Since I have one AND have the manual, please feel free to ask any questions about the device and its usage. I'll try to help as best I can.[/quote]

Madalot,

I'm sorry if I made it sound like I was refusing to give more detailed information. In fact I don't know all that much more than I posted. But I do find myself a little more uncomfortable about giving details than I would if it were about me. I have this feeling that it's not really my story to tell.

I'll definitely take you up on your offer for more information on the trilogy in and when the time comes. Thank you.

Midnightowl

MidnightOwl wrote:Midnightowl

That's fine. You don't need to share any more than that. I'm glad that my posts can help someone here. That's one of the things that has prompted me to keep posting -- in the hopes that there might be someone else that can directly benefit from some of my experiences.

Another thing to let you know is that I have found the information available on the Trilogy sparse at best. Since I have one AND have the manual, please feel free to ask any questions about the device and its usage. I'll try to help as best I can.[/quote]

Madalot,

I'm sorry if I made it sound like I was refusing to give more detailed information. In fact I don't know all that much more than I posted. But I do find myself a little more uncomfortable about giving details than I would if it were about me. I have this feeling that it's not really my story to tell.

I'll definitely take you up on your offer for more information on the trilogy in and when the time comes. Thank you.

Midnightowl[/quote]

Midnightowel --

You have nothing to apologize for. Please don't be concerned about that at all. I am a firm believer that a person should only share as much (or as little) as they are comfortable with. Please don't give it a second thought.

And yes -- you can ask me anything about the ventilator I have whenever you need to. I'm just a patient that is learning as I go, but will be happy to share any information I have gained through my journey.