1995 OPEN FORUM Abstracts
BiPAPTRACH: A NOVEL FORM OF AUGMENTING VENTILATION
P. Harrison. RRT; S. Jurgeson. RN; K. Christopher. M.D.; D. Onorato. M.D.; Respiratory Care Department, Hartford Hospital; Pulmonary Science Associates, Hartford, CT; The Intermountain Pulmonary Group, Denver, CO.
INTRO: Bilevel nasal continuous positive airway pressure (BiPAP) has been used as an effective method of reversing chronic hypoventilation in patients with neuromuscular disease, kyphoscoliosis, sleep apnea, and obstructive ventilatory defects. However, comfort, compliance and cosmetic issues have limited its usefulness. Additionally, some patients have chest and abdominal architecture that require in high inspiratory pressures in order to maintain adequate ventilation. We report our experience with a new application of a Respiratronics BiPAP device delivered through a variety of tracheostomy tubes (BiPAPTRACH) to provide a simple, economical and effective way to augment ventilation.
Methods: Patient failing nasal BiPAP support with respiratory failure were considered candidates for a trial on BiPAPTRACH. Inspiratory and expiratory pressures are adjusted to patient comfort while an extemal humidifier system was placed in line with the BiPAP ST/D. A whistle valve is placed down line allowing excess volume to be vented. Oxygen is delivered by a Respiratronics T-adapter and analyzed downstream. Additionally, optional transtracheal oxygen catheters have been custom miled to Jackson tracheostomy tubes allowing reduced oxygen utilization and enhanced ventilation during the day. Patients enrolled include: hypercarbic respiratory failure, sleep apnea syndrome, central alveolar hypoventilation, pulmonary hypertension, and patients intolerant to nasal BiPAP for cosmetic or comfort reasons.
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FINDINGS: BiPAPTRACH delivered through an extemal humidifier circuit provides an effective cost efficient well tolerated form of nocturnal ventilation in patients with chronic hypoventilation syndrome as well as patients with obstructive lung disease. BiPAPTRACH produces a sustained reduction in daytime CO2 and elevation of O2 in patients with respiratory failure and is well tolerated without apparent side effect BiPAPTRACH allows continuous phonation in communication and additionally provides independence from formal mechanical ventilatory support. BiPAPTRACH reinforces patient independence and self reliance since it acts to augment ventilation and is not perceived as a home ventilator.