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[Pressure] Bipap on Tracheostomy
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luvkher Offline

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Machine: resmed
Mask Type: Not using mask
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Humidifier: h5i
CPAP Pressure: 5/11
CPAP Software: Not using software

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Sex: Male
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Post: #1
Bipap on Tracheostomy
Hi
Can anyone guide on the BIPAP use with Tracheostomy.
?

Using a Resmed S9 on "Spontaneous" Mode with 8/4 setting.
Tracheostomy is uncuffed
No Obstruction in Trachea

The Leak value is 5/6

Question is , is it ok to have this high leak value ?, will there be any benefit with these high leak settings, i.e. normally if benefit with No leak to be rated at 100%, then with leak of 5/6, could it be 20% benefit

Kindly confirm / guide

Regards
03-18-2014 02:43 PM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #2
RE: Bipap on Tracheostomy
Hi luvkher,
I don't know the answer to your question but hang in there and someone will help you, soon.
Best of luck to you.

trish6hundred
03-18-2014 03:17 PM
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
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CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Post: #3
RE: Bipap on Tracheostomy
I wouldn't even feel safe answering your question because of the trach. Honestly, I think you should call your doc and ask this question.

Could you explain how you use the vpap each time you sleep?

I don't know how old this is but if I understand this correctly, vpap isn't designed nor recommended to be used with a trach.

http://www.mddcsoc.org/pdf/Bipap.pdf

https://paws.gru.edu/pub/respiratory/Doc...olicy3.pdf see page 1 where it says vpap is never to be used on trach patients.
(This post was last modified: 03-18-2014 08:29 PM by me50.)
03-18-2014 03:44 PM
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PaulaO2 Offline
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Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #4
RE: Bipap on Tracheostomy
I would assume you are using the bilevel as a breathing assist rather than as a treatment for sleep apnea?

If there is not air leaking at the valve, then my guess is you are sleeping with your mouth open at night. One easy way to check this would be to take an ace bandage or something similar and wrap it from chin to top of head once or twice. You want it tight enough to hold your mouth closed when relaxed but not so tight you cannot chew without effort.

If after a night with that the leaks are lower, then that is where the leak rate is coming from.

But, really, you ought to be asking your RT and not us. I doubt any of us could help you with this other than sheer guessing.

PaulaO2
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-18-2014 06:21 PM
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #5
RE: Bipap on Tracheostomy
I don't understand how the OP is using the vpap. no mask and lists a humidifier. guess I am just way to tired today.
03-18-2014 09:25 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Location: California, USA

Post: #6
RE: Bipap on Tracheostomy
(03-18-2014 02:43 PM)luvkher Wrote:  Using a Resmed S9 on "Spontaneous" Mode with 8/4 setting.
...
The Leak value is 5/6

Hi luvkher,

I assume a doctor is directing your BiPAP care. I don't know anything about PAP treatment when the patient has had a Tracheostomy. But I can reply to your question about pressure versus leak.

Pressure and Leak are fundamentally different and have different units. So we cannot combine the two as if they were the same type of thing.

It is incorrect to think that the Pressure would be 8 except that 5 or 6 of it is getting lost as Leak. It may be that none of the pressure is lost because of Leak. Even with Leak, the inhale Pressure (IPAP) is likely still 8 and the exhale Pressure (EPAP) is likely still 4.

An example of how Leak does not necessarily lower the Pressure would be when a tire is leaking but an air compressor is connected to the tire and is being controlled to maintain a desired air pressure in the tire. As long as the air compressor exactly keeps up with the amount of leak, the pressure in the tire will remain at its target value.

For CPAP the unit of Pressure is usually centimeters of H2O, which is a very small unit of pressure. For example, it would require hundreds of cm H2O to show at all on most tire pressure gauges.

The bi-level CPAP machine (like any modern CPAP machine) will automatically adjust itself to compensate for Leak and usually will manage to deliver to the patient its target Pressure (8/4 in your case) whether or not there is any Leak, unless the Leak is very huge and the machine is unable to replace the air which is leaking out.

The units of Leak are volume per unit of time, such as Liters per minute. The units of Leak are of the same nature as the units of Flow (airflow), some volume of air per unit of time.

CPAP or BiPAP treatment requires a certain amount of designed-in leakage (vent holes, perhaps like your Leak Valve) which provides at least the minimum needed amount of "intentional" Leak. The total airflow (also called "total Leak") coming from the machine needs to be at least sufficient to supply the minimum needed amount of "intentional" Leak through the mask vent holes (Leak Valve?) to flush out stale air from the patient's mask during exhalation.

If you are not wearing a mask, and if your Leak Valve is leaking air to outside your respiratory system (into the room or outdoors) perhaps your Leak Valve is providing the function usually played by mask vents, and perhaps 5/6 is a setting, meaning that the vent is five-sixths open.

If that is the case, then I would presume that the Leak Valve was adjusted until the ResMed VPAP (bi-level) machine reported a small (but not zero) amount of Leak. On ResMed machines, "Leak" refers to "unintentional" Leak, meaning the amount of leak which is more than the intentional amount of leakage needed to adequately flush out the old air during exhalation. On Respironics machines, "Leak" refers to "total" leakage, meaning a fairly large positive number for "Leak" may be needed to adequately flush out the old air during exhalation.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-19-2014 05:18 AM by vsheline.)
03-18-2014 11:37 PM
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Peter_C Offline

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Post: #7
RE: Bipap on Tracheostomy
(03-18-2014 09:25 PM)me50 Wrote:  I don't understand how the OP is using the vpap. no mask and lists a humidifier. guess I am just way to tired today.

I am *guessing* that since the OP has had a 'trac' done - rather than a mask, the machine's hose is directly connected to a 'port' of some kind in the OP's throat?

Again, only a guess on my part. I am unaware that the two are even used together, but my discussion on this topic was many years ago, as well as short.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
03-19-2014 12:11 AM
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me50 Offline

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Posts: 2,559
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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Post: #8
RE: Bipap on Tracheostomy
(03-19-2014 12:11 AM)Peter_C Wrote:  
(03-18-2014 09:25 PM)me50 Wrote:  I don't understand how the OP is using the vpap. no mask and lists a humidifier. guess I am just way to tired today.

I am *guessing* that since the OP has had a 'trac' done - rather than a mask, the machine's hose is directly connected to a 'port' of some kind in the OP's throat?

Again, only a guess on my part. I am unaware that the two are even used together, but my discussion on this topic was many years ago, as well as short.

http://www.mddcsoc.org/pdf/Bipap.pdf

https://paws.gru.edu/pub/respiratory/Doc...olicy3.pdf

it definitely says that vpap isn't supposed to be used with a trach, ever! I suspect that it is very dangerous for the OP to use vpap with a trach.
03-19-2014 01:13 AM
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robysue Online
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Post: #9
RE: Bipap on Tracheostomy
luvkher,

As others have pointed out, your question is really beyond the expertise of the members of this forum to ask. The vast majority of us are just patients with OSA being treated by CPAP or BiPAP, a few of us have CSA and use ASV machines. But we all have intact airways and so we really have no idea how a BiPAP can even be made to work with a trach.

You need to ask the doctor treating you this question.
03-19-2014 02:30 PM
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PaulaO2 Offline
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Posts: 8,067
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Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #10
RE: Bipap on Tracheostomy
me50, VPAP is ResMed's bilevel. Bilevel CPAPs are often used for those who need assistance with breathing, usually at night. It is not sleep apnea related at all. I know of several persons with cervical spinal cord injuries who use a bilevel only at night to assist them as a kind of mild ventilator.

From what little OP has said, it is apparent he knows what he is talking about. Someone with a trach would not just blithely hook just anything up to it.

That said, I repeat what myself and others have said and what Robysue said so eloquently, we just aren't the ones that can help you with this, luvkher.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-19-2014 03:44 PM
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