Bipap and Sp02 desats

[groggy]

Hi, just need your input on this. I work nites on LTC, we had this lady who has COPD with chronic resp. failure who is on the bipap 14/6 settings at night.

She would always have sats of around 65-75% while sleeping, appears not to be in any respiratory distress, though her RR's would be around 25, with shallow breathing. I usually will have to rouse her from sleep, make her do some deep breathing/coughing, sat would gradually come up. Or if that does not work, her sats would usually come up on 0xygen at 2 liter flow on nasal cannula. I have already put a report on this to the NP, so far little has been done, they put her on an antibiotic for respiratory tract infection, and they have discontinued tapering her off her prednisone. I feel so stressed out with her on the bipap at night, coz I have to check on her every hour at night, make sure the face mask is snug and fit, and everything is connected and the O2 bleeds 2 liter on the bipap. Treatment order states by the way that her sat should be between 88-92%. And to add pressure she is a full code with poor lung reserve, and the family is always breathing down your neck. Need help, pls. Thanks!!!

[Ariesbsn]

A RR of 25 doesn't jive with sats of 65-75%. Does she act hypoxic when you wake her? Are you sure you are getting a good reading from your oximeter? Does she have PVD? Does your oximeter also measure heart rate? How does her apical heart rate compare to the oximeter? If it is off significantly, chances are, you aren't getting a good reading. Is the head of her bed up at all? She may need her bipap settings changed or a tad bit more oxygen.

It makes me wonder if she is getting the oxygen when on bipap since 2 lpm per nc works. Maybe a service call from the bipap people to double check things wouldn't be a bad idea either.

[BBFRN, BSN, PhD]

A RR of 25 doesn't jive with sats of 65-75%.

It might with an obese apnic COPD'er that lives in the '80s% (assuming that's the case). How about trying an oxymizer? Sounds like she might fare better with that.

[circusdog64]

You will need a little research for this one. First, find out when her last sleep study was. Those settings (14/6) have a nice pressure support of

8 cmH20 and the FiO2 at 28% sounds like you should have a beter response to this therapy. Is it a nasal mask, does she have her mouth open while sleeping (open circuit)? Like Ariesbsn says does she seem hypoxic? Definately verify the SpO2 is correct w/ HR. Things are not right as they sit and you need to aggressively seek input from your Medical staff. If this is a home unit, call the company supporting it to come and check it out (most now have a card that runs them). Good luck!

[groggy]

Right now they have discontinued using the bipap at night, she goes on oxygen at 2 liters nasal cannula, satting around 86-92%. She will have a sleep study next week. We only use a portable oximeter in the facility, tried verifying the oximeter with my own finger which registered 97%, when i transferred it to her her finger the sat gradually dipped to 80-74%, heart rate range around 80-90's ( she was still on the bipap when i checked this). She seems a little bit dazed when i wake her up, but will be able to follow command. Thanks for the input, I will have to verify with the other nurses if the company renting the bipap has come to check her unit.

[groggy]

To baptized by fire, although she is not obese, it seems like she fit the criteria of a chronic COPD'er who lives with sats of 80's?. Uhmmm, by the way, what's an oxymizer?

[BBFRN, BSN, PhD]

Here's a link to study outlining the benefits of using an oxymizer with a COPD'er during sleep: http://www.erj.ersjournals.com/cgi/content/abstract/1/10/959

And here's what one looks like: http://www.chadtherapeutics.com/O224.htm

Please note that some people fare better with the BiPap or CPAP, but I've seen some do better with the oxymizer. You said this patient seemed to do better with the NC, so she might do well with an Oxymizer.