USING TRILOGY 202 FOR NON-INVASIVE · FOR NON-INVASIVE VENTILATION • Philips recommend that the...
Transcript of USING TRILOGY 202 FOR NON-INVASIVE · FOR NON-INVASIVE VENTILATION • Philips recommend that the...
March 2020
K.Dalton - CCOT
USING TRILOGY 202 FOR NON-INVASIVE
VENTILATION
USING TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
• ED prompt cards…
• Use BSUH infonet for NIV (BiPAP) or CPAP monitoring documentation.
USING TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
• Philips recommend that the trilogy 202 “may be used for both invasive and non-invasive ventilation” in clinical settings.
• It uses a single limb circuit, with an expiratory port (‘Passive circuit’) – this is essential for removing CO2 from the circuit. The machine blends Air and O2 and can deliver up to 100% FiO2.
• Non-Invasive Modes:
• S/T = BiPAP
• CPAP
• Using Trilogy 202 ventilators for invasive or non-invasive ventilation is an aerosol-generating procedure - full PPE should be worn for any confirmed or suspected infectious patient.
•
• Separate guidelines on which settings to use for specific patients e.g. COVID-19, ARDS, COPD - available from ICU team.
• Before connecting patient
– Ensure O2 hose connected to wall O2 or cylinder.
– Confirm ALL settings and alarms
– Settings must be determined by a competent clinician, seek help from ICU/Anaesthetics if unsure.
– Document treatment escalation plan.
USING TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
Trilogy 202
Bacterial Filter
Expiratory port
tubing
Additional Bacterial
Filter
Intersurgical circuit ‘passive’ REF: 5804011 / 5804000 Filter REF: 1544000
Philips Respironics circuit ‘passive’ REF:1065832 Filter REF: 342077 (REMOVE EXTRA TUBING and cap off)
SETTING UP OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
Trilogy 202 Bacterial
Filter Expiratory port
Attach to patient
NIV mask
Attach to patient
NIV mask.
tubing
• Video set-up: soon to be available via iris – see also link on microguide
SETTING UP OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
Trilogy 202
Bacterial Filter
Expiratory port
tubing
Additional Bacterial
Filter
CLEANING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
1. Clean machine and stand before and after patient use with decontamination wipes
2. Filter: single patient use change every 24 hours or earlier if damaged/soiled
3. Tubing: single patient use change every 7 days or earlier if damaged/soiled
4. Clean the ‘Air Inlet Filter’ as per instructions:
Air inlet filter ‘whisper cap’
2
2
Plug in machines at ALL times, even when not in use. Battery
life up to 3 hours if fully charged. Attach to patient
NIV mask / hood.
100% O2
PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
ON/OFF
Alarm Silence (2 mins) 1. Press for
Menu
2. Use to scroll through settings
3. Use buttons left and right to select / finish
100% O2
PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
Settings must be determined by a competent clinician, seek help from ICU/Anaesthetics if unsure.
Non-Invasive Modes: S/T – Spontaneous/Timed ‘BiPAP’ Spont breaths with mandatory (‘back –up’) breaths. Spont breath duration including I:E is determined by patient. Mandatory breaths - uses set inspiratory time and breath rate, only delivered if the patient does not trigger. SET: IPAP. EPAP. Breath Rate. Inspiratory Time.
CPAP – Continuous Positive Airway Pressure Only spont breaths. Continuous pressure delivered. ‘Flex’ refers to a comfort feature which slightly reduces pressure delivered during expiration phase. SET: CPAP, flex.
PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION MODES
BiPAP (NIV) Setting: Initial
value Comments
Dual Prescription
OFF
Dual Prescription allows separate day and night prescriptions for the patient, not used acutely.
Mode
S/T Spontaneous and timed. Display shows ‘Passive S/T’
AVAPS OFF Average volume assured pressure support – not used for BiPAP.
IPAP Start at 15
Aim 20. Increase if pCO2 not falling. Increase by 2 up to max 30.
EPAP start at 4
Can increase - Senior review required.
Breath Rate
10 Only for backup breaths, if patient is not triggering.
Inspiratory time
e.g 1.5
Only for backup breaths, if patient is not triggering.
FiO2
21 – 100 %
Aim target sats (usually 88-92%) Start at requirement prior to BiPAP starting (e.g. 35%)
Trigger Type
Auto-trak
Can be adjusted for complex patients, needs senior review.
Rise Time
2 Time taken at start of inspiration to reach full IPAP pressure. Measured in 0.1 sec (i.e. 2 = 0.2 sec)
Ramp
OFF
Nebulizer enabled
OFF Can use aeronebs attachment using additional equipment.
Setting: Initial value
Comments
Dual Prescription
OFF
Dual Prescription allows separate day and night prescriptions for the patient, not used acutely.
Mode
CPAP Continuous positive airway pressure.
Circuit Type
Passive
Single limb circuit with expiratory port
Flex OFF Can set to 1 or 2 to reduce pressure in expiration phase.
CPAP start at 5
Increase as required - Senior review required.
FiO2
100 % Start high and wean down – As required. Aim for target sats or paO2 as per senior clinician.
Ramp
OFF
Nebulizer enabled
OFF Can use aeronebs attachment using additional equipment.
CPAP
Settings must be determined by a competent clinician, seek help from
ICU/Anaesthetics if unsure.
• Video programming: (link pending)
PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION MODES
PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION
Settings must be determined by a competent clinician, seek help from ICU/Anaesthetics if unsure.
Rise Time (S/T) Expressed in 0.1 sec (i.e. Rise time 2 = 0.2 sec). The time it takes to change from expiratory pressure setting (EPAP) up to inspiratory pressure setting (IPAP) – Increased rise time = reduced time at maximum pressure in inspiration (Ppeak) but may be more comfortable and improve patient synchronisation. Trigger type (S/T) Usually set at ‘AutoTrack’. Determines how sensitive the machine is to detecting the patient’s breathing effort, sensitivity may be increased if RR is low (adjust to AutoTrack[Sensitive]). If RR is high, confirm that correct trigger type is set.
ALARMS: TRILOGY 202 VENTILATORS FOR INVASIVE AND NON-INVASIVE VENTILATION
ALARMS: TRILOGY 202 VENTILATORS FOR INVASIVE AND NON-INVASIVE VENTILATION
ALARMS: TRILOGY 202 VENTILATORS FOR INVASIVE AND NON-INVASIVE VENTILATION
ALARMS: TRILOGY 202 VENTILATORS FOR INVASIVE AND NON-INVASIVE VENTILATION
ALARMS: TRILOGY 202 VENTILATORS FOR INVASIVE AND NON-INVASIVE VENTILATION
For help using Trilogy 202 ventilators at BSUH:
• RSCH: CCOT bleep 8495 ICU SpR bleep 8413 ICU nurse in charge extn 62008 • PRH: CCOT bleep 6331 ICU Dr bleep 6010 Anaesthetics bleep 6442 ICU nurse in charge extn 8182
USING TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION