Saturday, August 27, 2016


As a Respiratory Therapist and mother of someone who is ventilator dependent, I'm always interested in new and different modes of mechanical ventilation.

Here are some of the ones we have used or tried out for my son, Josh.

1. the LTV 950 Ventilator. (there are newer versions of this ventilator in use now)


The LTV was a good ventilator and allowed Josh to come home and still breathe. But there were some things we did not care for with this ventilator -

the two-limb circuit was a bit heavy on the trach which can pull out and be dangerous.  And it had a valve you had to turn to set the external PEEP- it could break easily and was difficult to set just right

The air that goes into the lungs is powered by a turbine which is quite loud

there are so many buttons that could easily be inadvertently pressed changing method or mode of ventilation,

and the vent is heavy to carry - especially for a young boy.  We had to mount it to a stand, or cart. 

2. the Trilogy 100 Ventilator.

In my house, we like this ventilator much better.
It is lighter (11 pounds) and easily sits on a table top but can still be used on a vent stand.

  There are far fewer buttons and much less chance of accidentally changing a setting.

The ventilator operates with a very quiet blower, and just very user friendly.
We can use a single "passive" circuit - but don't forget the exhalation valve.
The PEEP is set internally, too.
It comes with a SD card that holds data from the computer important for the doctor.
It has an internal battery that can last 3 hours and a clip on battery that can run the ventilator an additional 3 hours.
You can use a car charger and run it in the car or hook to a big heavy "marine" battery to run it another 12 hours (in case electricity going out for long periods of time).

Of course that is still POSITIVE pressure ventilation - pushing air into the lungs - which is opposite of the way we usually breathe. Here is a video about the difference between positive and negative pressure ventilation:

3.  We have also tried out the Hayek RTX Ventilator.

 This is a big clear plastic shell that fits on the outside of the chest and forces open the chest, so you naturally suck in air and pushes air from the outside on the outside of the chest so you breathe back out -  that is non-invasive external ventilation.  Some people swear by this kind of ventilation. We thought maybe it would be something Josh could use and then not need a tracheostomy tube anymore.
Unfortunately for us, it did not work well for Josh.  First, the machine is LOUD -  like running an old timey vacuum cleaner.  It did not cause Josh to blow off enough CO2 - which is what ventilation is really all about.  And the shell was terribly cumbersome and uncomfortable - in fact painful - for Josh.

4.  Luckily for us, we learned about another tool for ventilation - phrenic nerve stimulators by Avery Biomedical.

They are like pacemakers to shock the nerve that makes your diaphragm muscle contract.  That forces you to take a big breath.  The electrodes are surgically implanted, sewn onto the nerve.  They are connected by wires inside the chest to a receiver that is placed just under the skin.  Then, you tape on antennas on the outside of the body over those receivers. 
The antennas send the signal from a transmitter box in to the receivers delivering the shock to the nerve.  And you dial in the number of times per minute to deliver the shock and cause a breath.  This method works very well for Josh most of the time.  You have to change the 9 volt batteries in the transmitter box frequently, make sure the antennas are in good shape (a new pair can cost over $500) luckily insurance so far is paying for a set per 6 months for him.  Josh's doctor has him using the pacers during the day as long as he's not sick.

When Josh came down with swine flu and double pneumonia back in 2010, the shocks and forced breaths caused Josh so much pain, he could not tolerate them and had to use the Trilogy ventilator 24 hours per day.  We find that as Josh is overly fatigued, the pacers do not work as well to blow off co2 as they do when he is awake, alert and moving throughout the day.  So, when he sleeps, he hooks up via trach to the Trilogy ventilator.

So, as long as the positive pressure ventilator is going to remain a useful tool for us to keep Josh alive and well, I love to check into the latest and greatest in technological advances in this area.

Some of the newer home ventilators I have been reading up on include:

The Revel by CareFusion

The Astral by Resmed

The Vivo by Breas


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