I currently work with ventilator dependent MD patients.
The pt is new vent pt. We have been having problems with I:E Ratio and low minimum volume alarms.
I:E inverted, ex: 5:1.1, or we are getting 1:1.1. Breathe rate is 32 to 50 during sleep! I called RT during night as was told to bump sensitivity from 2 to 9 and by pass LMV and put him continous Spo2 monitoring. Charted it. we were doing this for about a month, then I get pulled into office and told not to touch vent again. So for last 2 months have been answering LMV 20 to 30 times a night. Kept noting I:E ratios and breath rates on every shift I worked. Then RT comes in and is upset because we are not changing sensitivity as instructed. RN tell him that she spoke with another RT and they decided that the rapid breath rate was a normal sleep patten for pt. Alos during this time they did Co2 trending and client was staying at about 12% t\o nite. Now new orders are to increase breath rate to 18, sensitivity to 9 and by pass LMV alarm and use continous spo2 monitoring during sleep.
QUESTION. Does anyone know of a web site that has an explantion of I:E ratio, and what is normal range, what inverted signifies and the ramifications? I have been searching for weeks. Seem all I can find is results from studies on rats and mice or it involves cpap. Would like to better understand this, so I can knowledgably argue with RN about settings, and intelligably talk with RT about problems encountered.
Aug 7, '08
Hi first of all how old is the pt? what's his/her trach size? pt has MD means he or she is totally depended on the vent. All the above questions are very important as they all differ in setting a vent settings. If u have a peds pt settings are different if u have a 300 pound pt settings are different. I:E is the ratio of the amt of time it takes the vent to deliver a breath compared to the amt of time left to exhale the breath before the next vent breath is delivered. It is important that the client has enough time to exhale before the next breath is delivered. Thus, the expiratory time should never be shorter then the inspitatory time. LMV: low minute volume alarm is an extra safety alarm. this alarm can detect an accidental deccanulation, or disconnect, where the end of the vent circuit becomes partially or fully occuled, trapping pressure in circuit. In pressure control it can also detect an obstructed trach tube, if it is alarming all night first always check the pt this pt is on total assist control most likely if it is advanced MD see if there is any disconnection, suction if necessary and sometimes the RT sets the settings too low and the vent becomes too sensitive and the LMV alarm will drive u crazy for peds we set it at 0.2 ask your RT for accurate setting on that. sensitivity: vent monitors the inspiratory flow and the expiratory flow will adjust to make them equal. if the sensitivity is set a 1 LPM the vent will allow for a 1 LPM difference between inspiratory and expiratory flow before it will respond . clients with large tracheosstomy leaks may require higher sensitivity settings than those with cuffed trachs or small air leaks. The sensitivity setting must be adjusted for the vent to detect when the client is taking a breath this sensitivity setting determines how much resp effort or negative pressure the client needs to extert to activate the delivery of a breath. Sorry all this is so long but i love vent and i know them inside out i don;t like to depend on RT when i am in the home setting with a pt trying to save his or her life so i read a lot of books went on different sites and researched everything. Hope this helps.
Aug 10, '08
Pt 16, LMV set at 0.1. Pressure control at 20, pressure support at 12. insp time 1.0, volume 500, Hi pressure alarm 40, Low pressure alarm at 6. LMN 0.1 Breat rate 12, increase to 18 when sleeping and SIMV, not AC
Still getting inverted I:E in early a.m.'s usually starts at about 3:30 -:4:00, 4:1.1, 5:2.1, 1:1.1. Is 1:1.1 considered autocycling? On staff R.N. says no, R.T. says yes. R.N. says breathe rate in the high 30's o.k. R.T. says breath rate should be in mid to high teens.
Also Breath rate is elevated up to 50 at times. Usually stays at 28 -35 during deep sleep and heart rate will drop into low 50's. When awake heart rate is inthe 70 - 80"s range and breath rate is usually around 16. We use cont Sp02 monitoring at night, If heart rate decreases or breath rate up, I will ususally reposition. Repositioning will always change his breath rate, heart rate and breathing pattern to more normal values, Shiley #6 cuffless. Use safety strap to help avoid decannulation. Wish they would just put him on LP10. The vent they are using is way over kill. Pt can sprint up to 9 hrs a day without showing signs of decreased Sp02 or elevated heart rate.
Aug 11, '08
1:1.1 is autocycling rt is right br in high 30's is ok sometimes most imp is to check his BR is when he is sleeping this is most imp when u are sprinting pt off the vent. I am in NJ i don't know which state u are in but i haven't used LPIO VENT since 2 years now all our vents are LTV 950 OR LTV 1000. They are small compacted computer vents and much more useful for transport and travel than bulky LP10 vents. All the settings above looks accurate for a 16 year old any questions please ask thanks!
Aug 20, '08
Found a vent class given by Rt's going next month. That should clear up a lot of my question!
Must Read Topics