The Science Journal of the American Association for Respiratory Care
Introduction This is a 8-year-old ventilator dependent, quadriplegic, child with severe bronchopulmonary dysplasia, and achondroplasia (dwarfism) who despite such handicaps is a delightful cognitive appropriate for age and able to effectively vocalize via a leak around his tracheotomy tube; who without the support of the new T BIRD LEGACY home ventilator would need to remain in an Intensive Care Unit.
Case summery: The patient was admitted to our PICU for recurrent atelectasis and severe pneumonia. He was removed from his home ventilator and stabilized on our hospital VIP BIRD ventilator utilizing volume ventilation and a PEEP of 8. All attempts to lower the PEEP resulted in progressive atelectasis. The unique leak compensation function available in the VIP BIRD ventilator permitted consistent effective delivery of PEEP despite a leak around the patient's tracheotomy of 20 - 45 percent. Three attempts over a 2-week period to return him to his traditional home ventilator failed despite the addition of continuous flow and an external PEEP valve set to deliver 8 cm of PEEP. All three weaning attempts resulted in the patient becoming febrile within 48 hours, developing migrating atelectasis with worsening ventilation and oxygenation status. The traditional home ventilator with its external PEEP value was unable to maintain sufficient consistent effective PEEP in the presence of a variable leak. This left us with two options: 1) The patient would need to remain in our PICU on a sophisticated leak compensated ventilator, 2) Succumb to placement of a larger or cuffed tracheotomy tube that would eliminate his ability to verbally communicate. Fortunately, during this time a new generation microprocessor home ventilator the T BIRD LEGACY became available. The T BIRD LEGACY is a microprocessor home ventilator which via a fixed pitched turbine and a bias flow function is able to control and maintain consistent PEEP in the presence of variable and significant leaks around tracheotomy tubes. The patient made a smooth transition to the T BIRD LEGACY and was discharged to home on volume ventilation with 8 cm PEEP. Five months latter he remains stable and has return to school.
Conclusion: Application of the T BIRD LEGACY provided this patient with advanced lung disease the opportunity to remain safely and effectively ventilated in the home environment. The T BIRD LEGACY home ventilator has additional modes and functions that may offer other hospital bound ventilator - dependent patients the opportunity to make a safe, efficient, and effective, transition to the home environment. Further evaluation of the T BIRD LEGACY is needed.