NIV/ BiPAP vision machine on a tracheostomized Pt.

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Permalink Reply by ric mandanas on February 10, 2009 at 12:10pm

i presume the doctors in icu wanted to clear the bed and they can not wean the patient off the vent. Here in Hamad Hospital we have number of patients out of ICU and now staying in the ward with portable ventilator (HT50). We do have some patients mostly pediatrics using Bipap Trend or Respironics with small leak in the circuit (with uncuffed tubed for pediatrics)

"Do you agree with the treatment and finding it safe?" topics like this makes our "Kapihan sa RT department an endless discussion and exchange of views. I will let other comment first. lol.

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Permalink Reply by Lisa Martinez on February 10, 2009 at 3:09pm

My personal feelings are that it is not safe. Also have read it was not recommended. I believe I read it on the FDA website.

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Permalink Reply by Paolo on February 10, 2009 at 4:10pm

My buddy Prem from India said it was recommended by FDA? Whicj one is true? Lol. I think i need to research it myself.

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Permalink Reply by Zahara Zawawi on February 11, 2009 at 6:36am

I don't think it is an ideal situation but sometimes it is unavoidable and I have seen it in many hospitals. I had a tracheostomised Kyphoscoliosis pt with all the complications ( restrictive lung disease,cor pulmonale, chronic CO2 retention) discharged to the word then home with her Bipap machine which she gradually weaned herself off of and now only uses at night. and another Duchenne pt how was trached then sent to the ward on his Bipap then later discharged with it and is fully dependent on it.

I think the main concern should be safety. mainly the Alarm setup. because the pt is in the word you cant be %100 sure there will be a nurse or RT at bedside all the time. So you need a laud and dependable alarm. As long as you are using the Bipap Vision which has an advanced alarm system then hopefully you are safe.

As for whether it is "correct" practice, I really don't know!

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Permalink Reply by ric mandanas on February 11, 2009 at 8:46am

same situation encountered here zahara, we are doing for same therapy regimen specially designed for them. For us practitioner, we have to consciously set the alarm limits safely. Understanding the effect of our chosen device to specific patient (obviously explaining it to them or to nurse/or family)

RC practitioner should always keep a conscientious attitude towards work for patient's safety and eventually their recovery back to good health. Device or equipment cannot work properly without a therapist cautiously setting it up to the patient's adaptability to treatment.

In our profession from time to time I'm faced up with a decision to do treatment ordered by the physician but contrary to what I have learned from books or experience. I'm aware that most of us here do too. Next step is yours to take. It is a part of molding of a good respiratory care practitioner.

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Permalink Reply by Paolo on February 11, 2009 at 2:38pm

Thats the thing. Most of the wards in a hospital dont have 1:1 nurse to pt ratio. And sometimes the minimum time the ward RT can visit the pt. is q4h. One issue also is pt is tracheostomized, bronchial clearnce is a big issue. (nurses are just to lazy to suction LOL). Plus the availability of proper monitoring equipments.

But how about the idea of using a bipap machine (bipap vision) as a replacement for a proper ventilator? Like rather than put a pt on Bipap, why not an LTV home vent or an Oxylog transport vent?

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Permalink Reply by Chris on February 13, 2009 at 6:17am

The Vision is approved for invasive ventilation. I use it frequently for patients requiring an increased FRC(PEEP). The biggest issue is humidification, since there isn't a heated wire circuit available. I wouldn't use in on the floors on patients needing a significant amount of inspiratory support. I would also use a Spo2 monitor. If a patient requires inspiratory support, greater than +5PSV, we use the LTV1000.

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Permalink Reply by Paolo on February 13, 2009 at 8:43pm

Thanks Chris! This comment is great.

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Permalink Reply by Bill Garrison on February 19, 2009 at 6:52am

There is a heated wire circuit from fisher paykel and our Medical center use it with our bipaps all the time. The rainout is miniminal. Works great!!!

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Permalink Reply by Bill Garrison on February 19, 2009 at 7:06am

I do agree when the PT needs minimal support. The needs for critical care beds are high and when the PT is stable enough it benefits the PT due to the high risk of infection in the ICU. The PT is transferred to a monitored floor for safety. With the proper train staff it works well and the cost is reduced. We use Vision Bipap

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Permalink Reply by Sheryl on February 25, 2009 at 6:03pm

We all know that BiPAP is actually made as a non-invasive ventilator but here in our hospital (KAUH, Jeddah) we did use BiPAP Vision to some tracheostomized patients who doesn't require ICU and were transferred to the wards. No study have been done yet, but so far the outcome was beneficial and no adverse effects noted. And yes, there's a heated wire circuit available from Fisher & Paykel.

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Permalink Reply by emily arizala delute on August 6, 2009 at 12:36am

Sorry for the late reply, i just read this topic, asking how will u connect the Vision Bipap on tracheostomized pt, its on his trache????, knowing that Vision Bipap is NIV from the word noninvasive. I had 1 pt here shes RF2, tracheostomized 2x, afraid to decannulate with recurrent admission due to hi CO2, with respiratory muscle weakness, now she was connected during night on portable bipap machine which is VPAP, via nasal pillow trache tube was close, i mean with button, no averse reaction was noted...Any comment regarding this, as of now we dont have any protocol

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