Could you give me questions for my mother's pulmonologist? or other help please?

[Helena]

My mother, who is 93, uses a ResMed Astral 150, with a non-heated humidifier and oxygen at ca. 3.5 liters. There is a modem that sends info to her pulmonologist's office and to Apria.

She told me this morning that she feels she can control her breathing better when she is awake than when she is asleep. She says she feels at night, with the ventilator, that she is trying to breathe and cannot get air.

The resp. therapist from Apria recently came and set her up with the mask that has plastic tubing instead of straps, and the air goes in at the top of her head, to try to prevent mask leaks.

Could you please help me improve things for her? It is not at all likely that she would let someone in the family re-program her ventilator, but--

is there something I can ask the pulmonologist to order, or take care of?

I asked her to have him order a private respiratory therapist to come out, through the agency that sends nurses and physical therapists, because the respiratory therapist from Apria has loyalty first to Apria, not the patient.

(I told my mother that the Apria respiratory therapist has conflict of interest, and we want an independent view of things.)

She has a replacement heart valve and a pacemaker.

Thanks so very much.

[SarcasticDave94]

This is a high level ventilator instead of the CPAP class of machine. It happens to be the one my own RT wants me on.

Basic steps first, check the hose, as in the full air circuit, for leaks or defects. Check and replace the filter. Also check the supplemental oxygen section for good, solid connections.

Next, the RT or whoever is trained to perform pressure edits should verify operation mode and the settings contained within. Modes will be among others, PAC and iVAPS. There should be EPAP and PS settings to verify. These are similar to CPAP pressures of the same name. There could be a time group in there, timing for breath is what I'm meaning.

Feeling a lack of air can be physical hose connections or breakage of these or therapy needs have changed and requires increases in probably EPAP Min, again similar to PAP but there's more settings that can be involved.

I'd look at basics first then move on to the pressure program.

[Helena]

Sarcastic Dave 94, thank you very much.

My mother used her ventilator to nap this afternoon in her recliner, and said she did better than last night. I asked if it was because she was not lying with her head so far back, and she said she would try having her head higher tonight. That is her way of saying that maybe having her head higher helped her breathe better.

She has a Sleep Number Air Bed, an older one, that will raise the head and the feet, so she can have her feet higher than her heart, and still have her head at a high incline.

Thanks again for your help. We will pursue your suggestions.

[SarcasticDave94]

OK best wishes you get it resolved. Keep us updated if you would.

Bonus: Adjustable beds are a big help.

[Helena]

With the air hose connected at the top of her head,
with the tubing instead of straps on the mask,
with folded towels tucked under the sides of her pillow,

she has not had any of those short episodes of respiratory distress, as far as I know.

Have not been able to get other family members to agree to having the respirator therapist from the DME come out to check settings on the ResMed.

She does have a new, inline filter, too.

Other family caregiver is checking physical connections of mask, hose, ResMed, humidifier, oxygen, modem, concentrator, power supply, etc. And making sure nothing is pressing on or disturbing the oxygen tube from the concentrator.

We also check oxygen levels with pulse oximeters several times each day.

We move the ventilator to another room for her to nap in a recliner sometimes, so it means checking connections a few times a day.

Family caregiver switch in a few days, so will have frontline view soon.

[Sleeprider]

Be careful about placing the head at a high incline causing the chin to tuck. This is a classic formula for what we have come to call positional apnea. When the chin tucks toward the chest, this compresses the soft tissues of the throat behind the chin and occludes the airway. This can prevent air from passing until the patient moves and opens the airway. You can simulate this problem yourself, or with your mother. Sitting in a comfortable chair or even in bed with your head inclines, relax as you would during sleep. As your neck relaxes and your chin moves toward the chest breathing becomes increasingly difficult or impossible. It makes no difference how advanced the ventilator is, a non-invasive ventilator cannot penetrate positional occlusion. This is so common, we often suggest the use of a soft cervical collar to prevent it, and have several wiki articles to discuss it:
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar. http://www.apneaboard.com/wiki/index.php...cal_Collar

Try the exercises to screen for obstruction. If you notice that raising her head causes difficulty with breathing, consider avoiding that position or taking precautions against chin-tucking. This is a very very common problem and it could be that by trying to make her more comfortable, you are actually making your mom more vulnerable to it. This physical obstruction can be avoided with a soft cervical collar or more invasive airway protection.

[Helena]

Sleeprider, I just saw your post. Thank you very much.

Her pulmonologist told her, after her neck was accidentally broken at an in-hospital sleep study, that she should never fall asleep with her head falling forward, such as in sitting in a chair.

Your post explains more reasons why that is dangerous.

I will tell the rest of the family and the caregivers.

Thank you!!!

[Gideon]

Please pardon my curiosity, How does a neck get "accidentally broken at an in-hospital sleep study"?

[Helena]

I don't mind.

When my mother got into the bed, for the sleep study, my mother noticed that there was something sticking out of the bed frame. She told the nurse that it needed to be attended to and put right. My mother and the electrodes spent the night in the bed for the sleep study.

Hospital staff did nothing about the protruding bed piece.

When my mother got out of the bed in the morning, she tripped on it, went flying, hit the wall, and her neck was broken.

The doctor apologized and made sure she was not charged for the hospital stay.

The recovery was very long, and the damage from the break has made her life more challenging.

We check all hospital beds now, and try to have someone with family at the hospital at all times.

[Sleeprider]

Since the pulmonologist is aware of this , ask abou using an OTC cervical collar. I bet a properly sized collar could make a huge difference.