"please keep me updated about oximeters "
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Rock Hinkle: Bi-level Titration
You are titrating a patient on bi-level. The patient has slept well and you've found what seems to be the IPAP and EPAP needed for this patient. The patient has COPD. Can you adjust for Rise Time, Ti Maximum and Ti Minimum, Exhalation, Trigger and Cycle Sensitivity to improve therapy any further? Or is IPAP and EPAP need the extent of your titration?
Betchya this one "ain't" on the exam!!!! *wicked grin*
Views: 238
Replies to This Discussion
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Permalink Reply by Judy on
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So - its not enough to find a sleep lab w/a good RPSGT, I have the next to impossible task of finding a good sleep lab w/a good sleep doctor who will recognize what the good RPSGT is pointing out to him. Snort! Mission impossible. Better yet, I find a sleep lab w/a good RPSGT and a dumb or disinterested doctor who just signs off on the RPSGTs suggestions!!!! That's an easier goal. And more realistic.
Thanks, Rock HInkle.
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Permalink Reply by RockRpsgt on
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As long as the interpreting doc is a pulmonologist he/she would, or should understand what the tech was trying to accomplish.
Judy said:So - its not enough to find a sleep lab w/a good RPSGT, I have the next to impossible task of finding a good sleep lab w/a good sleep doctor who will recognize what the good RPSGT is pointing out to him. Snort! Mission impossible. Better yet, I find a sleep lab w/a good RPSGT and a dumb or disinterested doctor who just signs off on the RPSGTs suggestions!!!! That's an easier goal. And more realistic.
Thanks, Rock HInkle.
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Yeah, well, the only sleep doctors I've seen have been pulmonologists, except for one sleep neuro years ago after the whiplash. I can't say I am impressed. There's a rotating group that covers the sleep lab I use and there were a covey of three that covered the hospital sleep lab back when I had the whiplash. They are all pleasant. Just not all that interested or "into it". Come back in three months, come back in six months. What for? I say I'm doing better, BUT, not as well as I was. Here's the data .... oh, yeah, a quick glance - we can raise your pressure 1 cm and we'll see you in six months, or three months ... and then there is the blithering idiot at Mayo who would rather rant about the uselessness of the PAP data than discuss any therapy problems. He's a pulmo.
What's the problem when you have a problem patient with taking a thorough look at the PSGs again and then at the trending data from the xPAP?? Duh!
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I"m just tired and grumpy tonight and can't sleep. Am all slept out from the sedation. I HATE sedation!!!! And they hit me three ways!!!! Benadryl, demerol and phenergan. Talk about overkill!!!
I wanted just the local lidocain and IV propofol.
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I HATE it! I don't like being loopy and groggy. W/propofol you are awake almost instantly after they quit administering it and there is no after effect of grogginess and confusion. You are awake and alert and aware. I am NOT a child of the 60s. I don't like being "high".
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Dang it, jnk. I HATE it when you make so much sense when it is NOT what I want to hear!!!. *weak smile" I suppose you are right. Maybe.
The problem w/ME adjusting the Ti Max or Ti Min and even the Rise Time is that I have to be awake to do so. And I have NO IDEA how long to lay there - awake - and uncomfortable w/that too abrupt transition - before I try another setting. I've tried and had it SEEM to get more comfortable for less than a minute or two - and then the transitions start getting too abrupt again. So I try another adjustment - and it seems to improve - and then starts getting uncomfortable again after a minute or two - and I end up being awake all night waiting to make yet another adjustment.
But ... thank you ... I guess.
So - much as I hate the idea I will check into renting a Respironics bi-level auto for a month and see if we can FINALLY find the IPAP and EPAP settings I need since I absolutely wasted this recent titration by not sleeping phershtunga or long enough for them to determine what pressures I need.
Buying an APAP out of pocket is one thing. Buying a bi-level out of pocket is a lot more painful ... even at auction.
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Permalink Reply by Mary Z on
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jeff, do mind telling me your Ti Max and Ti min. Mine are 3s and .3s with a rise time of 300s.
Actually what I'm wondering is what a locigal difference between Ti Max and Ti Min should be. 0.3s doesn't make any sense to me.
Thanks, Mary Z.
j n k said:ResMed has TiMax and TiMin. The TiMax adjustment is very important, but I am not aware of any RTs who go out of their way to figure it out the way the ResMed clinician's manual describes how to do it. A bad TiMax adjustment can absolutely ruin therapy, and I am one who needed a longer TiMax than the default and had to set it myself or I would never, and I do mean NEVER, have been able to sleep with the machine at all.
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We do have control of those settings during our titrations. Thanks to Judy and great RT instructor I do understand how they work. Like jnk said most techs do not. Unfortuanately I have never had an opportunity, or a need to adjust any of these settings.
Nice explanations jnk
I also do not want to push RTs out. I am very appreciative of the RTs that have helped me in my journey. Respiratory is a part of sleep.
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Ahhh, jnk. Where WOULD I be w/o the likes of you and Rock HInkle and RestedGal and so many others in these forums?? You are such a voice of reason when I get off on a tangent.
We can't seem to find the right IPAP and EPAP w/my VPAP Auto and since I blew the recent titration by not sleeping enough ..... its try renting a Respironics bi-level auto for a month to see if their PS allows for a better auto titration for me and if that doesn't work paying out of pocket for another in-lab titration and taking an Ambien as insurance that I sleep.
I'm still upset w/myself that I didn't sleep during the titration or that it didn't occur to me that I might not and brought an Ambien w/me just in case. I just don't understand WHY I didn't sleep - except the excitement that THIS time we were going to get THE pressure settings I need. *sigh* I well remember how well I was doing. *sigh*
We've added the 2L of 02 supplementation back w/the PAP so while I have apneas and hypopneas no desats are below 90 and for 95% of the night my sats are in the mid-90s. So its the sleep fragmentation that's the problem, I guess.
Each step has been an improvement (CPAP, pressure adjustments, bi-level auto) until the COPD exacerbation early last year necessitated a pressure adjustment - its been a matter now of finding WHAT pressure settings are needed. As you know we've managed to erase the too abrupt pressure transitions in Spontaneous mode by staying in Auto mode w/the PS set the distance between IPAP and EPAP. I don't care about not using Spontaneous mode since Auto mode will work IF we find THE right IPAP and EPAP. I thought this recent re-titration would do that - and maybe there would even be time to try finding the right comfort settings in Spontaneous mode altho that was NOT my main goal. I just want the RIGHT IPAP and EPAP settings that I need now.
I just started this thread to see what if anything could be done w/the in-lab PSG for Spontaneous mode - and to try to stump Rock Hinkle. *wicked grin*. So my rant got us off tangent. I'm just turning into a grumpy old witch. I like being a crochety ole broad but I don't like being a grumpy ole b*tch which is what I'm becoming again. Not quite so bad as I was before starting CPAP but .... I'm sure seem to be working on that!
(((hugs))) to you and to all those who have been such a help and blessing to me!
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That's ok jnk, I had no idea what they were until Judy brought them to my attention. That was a year itno my sleep career. Even knowing about them now it never occurred to me that these settings may help Mary. I will try to find my notes.
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