A VERY important message for Ventilator patients!

Hello. How are you? Well I'm doing pretty good. for the last two nights in a role I've ended up with water in my lungs that is a result of the Condensation build up in my ventilator circuit. I have a drain on the exhalation side of the circuit, and it gets completely full pretty quickly but I think I'm moving around in my sleep or something because it seems that water from the inspiratory side  gets blown into my lungs which I'm going to add right now is VERY VERY uncomfortable. OK, this is a VERY VERY IMPORTANT WARNING, from a ventilator user to all ventilator users or  soon to be ventilator users. It  is VERY serious and I have a feeling you will thank me if  you have to see both sides of the DME system, being those that give you a Non-Heated Wire Humidifier system and a Heated wire System, you'll learn that a Heated Wire is A MUST for all ventilator users that use humidifiers, and I think ALL SHOULD BE using humidifiers. I've seen videos  where the HME is the primary means for humidification. I don't like this, and I wouldn't be able to tolerate it. I'm just barely tolerating what I have to deal with which is a Non-Heated Wire System, and trust me, if you have to deal with this system especially on LTV circuits you will certainly realize how much better it is to have a heated wire circuit.

OK, so Let's begin with the basic system which is a Non-Heated Wire Circuit with heated Humidification.

OK, We'll use our patient who I've decided will be an infant.

Pediatric home ventilation  has become a MAJOR thing now days with vents like the LTVs and the Trilogy vents, but in  this example, we will be using the LTv throughout because It's what I've had experience with, and the only vent I'll use if I can help it, because of the ICU ventilator Nature of the LTV vents which is the kind of ventilation that I need! This means that If I'm ever given an Option of a Trilogy, I'm going to have TWO words! "ABSOLUTELY NOT!"

I'm staying with my LTV unless somebody offers me an Evita XL then I'm leaping for that, but Not a Trilogy and CERTAINLY not anything old like the LP10s! Although I think those things are going out and they'll become like the MA-1 vents and that means OUT OUT OUT! LOL

OK.

Case: We have Aiden who is a 10 month old with Trisomy 18 who is on ventilation essentially 24/7 with some short periods off the vent but when He's off the vent he requires Higher Oxygen concentrations, and these periods off of the vent may last from anywhere around 10-15 minutes at THE  MOST.

OK, so Now Aiden has a humidified circuit WITHOUT a Heated Wire. What does this mean?

Air and oxygen go from the ventilator to a short tube to the Humidifier where It picks up heat but then as It's going through the Inspiratory sids of the circuit the surface areaof the circuit is cooler than the temp in the chamber and guess what. It loses that condensation and water collects in the tubing! This means that Aiden'sMom and Dad have to get up every so often and empty the water out of the circuit.  Well for the first several months after a couple of nights with a circuit, we get a really really ridiculous and annoying problem.

BEEP BEEP BEEP!! Aiden's Mom gets up at 01:00 and what do ya know? The DISC/SENSE alarm is going off. Usually that means a sense line which is one of the trandsucers has become disconnected, or blocked by something. Aiden was sleeping so well at the vent's set rate of 35 breaths Per Minute and Now he's awake and anxious. The vent is Autocycling!  Great, and the tubing is rattling because of the water that is moving in the tubing. It's like sort of a water hose and It's only a matter of time before Aiden gets a very unpleasant spray of water, WHERE? IN HIS LUNGS!!! NOT GOOD!!! So Now She takes Aiden off the vent hoping to empty the water from the circuit into a bucket she's already got just for this purpose! Aiden is off the vent for a short period of time whilst she does that and well she puts the vent back on and Aiden starts getting really upset because even though the Disc/Sense alarm has stopped for what will be a few seconds now when he inhails, the vent's Exhalation seems to be stuck or something is weird because He's not getting a breath  and the low Pressure Alarm is going off. Maybe even the Low PEEP alarm if that is turned on and It should be turned on!  Aiden's Mom notices that there's no Pressure Increase when Aiden Breathe as there should be because of the 16 of Pressure Support that's set above the 10 of PEEP giving a total PIP of 26cmH2O when he breathes in. Now there's a problem. she takes Aiden off the ventilator again, and calls for her Husband to bag him whilst she's troubleshooting the thing. She feels throughout the circuit and UH OH, there's water literally draining out the Exhalation valve and It is  soaking the sheets. She shakes the valve  whilst  Sean her Husband bags Aiden with 10 L/Min of flow from the Oxygen Concentrator, as Now Aiden's Pulse Oximeter is going off because He's getting upset and now getting the air and oxygen that he needs.

Sean gets Aiden's Oxygen sat up whilst His Mom shakes out the valve and thenthey put the vent back on him!
OK, they watch the vent for a few minutes and then go back to bed. No sooner than 30 Minuets later, BEEP  BEEP BEEP!!!!" Aiden's Mom had just gotten back to sleep when this thing happens again. She goes in hoping that he just needs to be suctioned and that It's not another round with "DISC/SENSE!!" And as she enters the room, Guess what. The red LED display above the settings displays reads "DISC/SENSE!" "OH GREAT, Really," His Mother says silently!  She looks at the exhalation valve which is  soaking the sheets again. Aiden requires the Highest level on the Humidifier setting so the knob is maxed out.

NOTE: This is My situation, because anything lower and I get bloody secretions and a very high amount of Plugging going on!" NOT  FUN!!

So Aiden's Mother shakes the valve and then decides to tap it some to get what she can out of the valve but then there's another problem!! Now when she tapped it the valve is making a vibrating sound and Aiden is getting really upset again. "UH OH," she has just dislodged the diaphragm in the exhalation valve. Now she cold try putting something in the valve to push it back in place but It takes great skill for that and It's not a job for somebody half  asleep. Now the vent is reading Low PEEP  because the exhalation valve which is now out of place is giving Aiden a PEEP of 2cmH2O instead of the 10cmH2O that he needed! NOT A GOOD THING.   So NOW the LTV 1150 with It's Internal PEEP cannot possibly set the correct PEEP level with the valve out of place. Her Husband comes into the room to Bag Aiden who's really getting upset now and who's sats are soon to start Literally TANKING if  they don't get his breathing back to a normal pattern. Aiden desats very easily. So now he is being bagged on the oxygen concentrator with the PEEP valve set at 10cmH2O and then after that she tries to tap the valve back into place,  with a small test lung being the simulated lung. Well NO JOY there. After 20 Minutes She says to her Husband, "I just put this circuit on a couple of days ago, but It looks like we've gotta change the thing, and  I'm calling them in the morning to tell them we waqnt a set up like In the Hospital.

In the Hospital,  Aiden was on an Evita XL ventilator with a Fisher & Paykel MR850 Humidifier and then when they transitioned him to the LTV 1150 they utilized their heated wire LTV circuits with the MR850 and had NO PROBLEMS!! Now that they  are finally home after 10 Months In the Hospital because of Aiden's continuous drift into stability and instability, they were given a Fisher and Paykel HC150 Humidifier which is Not really sutable for any ventilator, because It's more for PAP therapy,

She changes the circuit and things stabilize for the rest of the night with occasional awakenings to empty the circuit when condensation flooded it. A  few hours after daylight  when the  DME opens, Aiden's Mom calls the DME and explains the issues and they say, "O, We do not have heated wires!" So now for one more night Aiden's parents sleep well with only occasional periods of having to get up and empty the water out of the circuit, but then the DISC/SENSE alarm starts again and the process begins requiring another groggy circuit change. Finally she decides to try something. Aiden happens to have a trach collar setup available in the event that he does get off the vent for a few minutes and shoe grabs a long tube from the closet that would usually go to the trach collar set up and cconnects that to the exhalation side of the ventilator circuit where the exhalation valve's  section of tubing would go. She then connects an extra Humidifier chamber with the Number for this chamber being 325 and then she conects the small section of tubing to the other sideof the chamber where the exhalation valve will connect to, and after that, she pushes the exhalation valve section of tubing onto a hook on the ventilator's stand so that It will be upright. So now, water will drain into that home made water trap, well, unless Aiden turns a certain way or the water collects in very profound amounts in the inhalation valve. So that night Aiden's Parents occasionally go in to  hold up the exhalation side of the circuit or the inhalation side of the circuit and let them drain into the water chambers, but then at 03:00 during the wee hours, Suddenly Aiden's Mother as awakened by what sounds like Aiden moving around and coughing and the ventilator alarm starts going off as well as the pulse ox. Now when she goes in there Aiden is very upset and is coughing whilst the High Pressure Alarm is going off. UH OH, Aiden has just gotten a  shower, only it was IN HIS LUNGS!! She takes the vent off and suctions Aiden. She's not sure what's actually going on but then she hears a rattling noise in his chest and when she takes the vent circuit off the vent sprays her with water. Now we've got a vent circuit that's now a water hose, and even though some of it is draining into the humidifier chamber that is being used as a water trap, the water in the inspiratory limb is not being drained. she could put a trap on the inspiratory limb, however that could decrease the pressure that is inside of the circuit, and cause further problems!

OK, so Now we've seen that a heated but Non Heated Wire Circuit is not a pretty sight, and is VERY unpleasant with it's condensation and the issues that are mainly related to the water that gets left in the tubing! Now let's visit the Heated Wire circuit!

So Now Aiden's Mother finally realized that it was not working out well with Aiden and he didn't get Pneumonia from that eisode but he certainly isn't so comfortable and relaxed on his vent like he was, and will often try to pull it off. She realized that with his high humidification requirements He needed a heated wire circuit and that was just it! She decided that she was going to have to get another DME provicer, and so she found another ne with a heated wire system. Now Aiden was given a Fisher & Paykel MR850 Heated Humidifier, and from there on out it was smooth.

What is different about this Humidifier vs the Other kind that do not have heated wired? Well to start the heated wires are there to prevent or at least reduce condensation. With these systems there is a heater probe at the humidifier chamber and at Aiden's End. there is a heating wire that runs along the ventilator's circuit and what this will do is it will heat the tubing up according to readings generated by the probe at Aiden's end that tell the heater what the temperature is inside of the circuit. So now there is a much smoother air flow through the ventilator circuit and on the Humidifier if you look in the front on the display screen you will see that the display should read at or near 37 degrees C and so the water and the air temperature are continuously monitored and the temperature is closely regulated so that Aiden gets at or around 37 degrees C and so that His airways are not so dry and he does not get a lung full of Water.

I feel that ALL DMEs should be required to have the heated wire circuits if they're offering home ventilator care, because otherwise you're in for a rough ride if you have the high humidification requirements like Aiden and I do. I try to turn my heater's knob down but even a slight bit and I'll get more plugging episodes and it is MUCH more uncomfortable, so mine is at the max setting and it looks like that's how it will stay unless I get a Heated Wire or unless somehow I'm allowed to heat my room up to over 100 degrees, but then Momand Dad would not agree with that and even though I'd be perfectly fine at that temp anybody else who came in would start coughing and gasping for air.

LOL!

I remember several years ago when my nephew came into my room, and I'd had my heater maxed out, and my room was well over 90 degrees. I was comfortable, but he started coughing andgasping and RAN OUT! It still makes me laugh to this day.

But I don't want to get off subject here. The Point is, YOU NEED a Heated wire Humidifier if you have that option because It is what will give you  the best humidification.

So, if you get that option, between a Heated wire and Non-Heated wire circuit setup, I'm telling you that YOU REALLY NEED to take that heated wire circuit setup and PLEASE, stay away from humidifiers like the HC150 because well their chambers don't have a spike and a gravity infused water  system and  you not only have to refill them, but  they are a pain when the knob gets moved accidentally, because the knobs are so loose and even picking the thing up or moving it or just turning it will cause the knob to move, so you have to check the knobs quiteoften.

Thank you for reading another blog post, and may God Bless you and Keep you.

Remember, ONLY HE, can love you PERFECTLY!!