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Big Al
05-05-2009, 06:35 AM
Ltv950 kid sleeps with his mouth open dosn't set off the lp alarm but the vent will triger paient effort and keep giving small breaths inbetween the normal ones. Any tips? am I on the right track with the open mouth or am I missing something. He isn't in any distress pulse ox is good to. It just looks bad to document a resp of 34-40. When he is awake or has how mouth closed no trouble. Driving me nuts (I'm a slghtly anal)

Niff
05-05-2009, 07:45 AM
I don't think it's the open mouth that's the issue. Does your client have a "usable" upper airway? I'd advise you to check the vent circuit and make sure there's not any water/condensation built up. If there is, the slushing of the waters back and forth will trigger the vent that he's inhaling.

We had this happen the night before last with Mackenzie. The vent was alarming high frequency, but when we looked at her she wasn't working harder or having retractions that would accompany her being tachypneic. When I listened to her with a stethoscope we heard slight rhonci (which isn't unusual for her), but then I noticed she was stacking her breaths. I checked the circuit and sure enough there was a teaspoon of water (maybe less?) in it. After dumping the water and reconnecting the circuit, her respirations went to their normal range and she was no longer stacking her breaths.

TommysDad
05-05-2009, 07:53 AM
As Niff stated, water in the line will certainly do this. However, if your child has a usable upper airway, it is possible that the "leak" is causing the vent to cycle. We had this happen right after Tommy's stent was removed for his first LTP. They changed him to a cuffed trach (be sure to get a tight to shaft, as there is concern that the others can lead to additional trachea damage, and these maximize air flow for communication when deflated) and we would inflate it at night, only when he was "cycling". It worked well. Tommy's airway closed quickly afterwards, and we no longer need to inflate it.

Ann
05-05-2009, 08:18 AM
If it's not water in the circuits, it's likely an air leak causing the cycling. As already pointed out, one option is the cuffed trach or, a simpler solution is to increase the sensitivity on the vent. You should probably get permission from your patient's physician to make the change (as a parent, I wouldn't ask for "permission" to play with the sensitivity, but as a nurse - you need to for obvious liability reasons). Increasing the sensitivity usually does the trick. Keep in mind that the higher the sensitivity, the more difficult it is for the child to trigger the vent with his/her own breath. Therefore, how high you can go on the sensitivity will depend a lot on why your patient is vented.

Alex's mom
05-05-2009, 08:57 AM
Our child is vented and has an uncuffed trach - sleeps sometimes with her mouth open and has a big leak especially when she's sleeping.

An RT once explained to us that the air leak, in a way, tricks the vent into thinking that she is attempting to take a breath. So when her RR would normally be 18 while sleeping, it is in the 30's and 40's. We change the sensitivity on the nights that it's an issue. We have a standing order from our pulmonologist to do this. We haven't ventured into putting a cuffed trach in yet, but I'm sure we will be doing this sometime in the future.

Hope that helps. :)

Esties mom
05-05-2009, 10:41 AM
we had that happen too, first went up to 7 on sensitivity then went up on volume support even thought its turned off, it worked great. no more leaking. She did not like a cuffed trach

lynn
05-05-2009, 12:27 PM
Also, very obvious choice for leak- are the circuits hooked up tight, and not broken anywhere? I get this happening alot in the crib setup because Joseph climbs around so much, and I have the circuits tied to the rails(in a downward slope because of the water buildup)- so the circuit doesnt move freely with him- alot of times the yellow or white sense line comes a little bit unscrewed-it doesnt alarm low pressure, but auto cycles- I always check the water in line first, then the sense lines where they screw into vent-usually this solves the problem (we are also on sensitivity of 8 because Joseph "snores" with mouth open)

Big Al
05-05-2009, 11:38 PM
I empty the accumulated water in the circut about every hour so I dont think that's the issue. He has a pmv on so he has to exhale through his mouth and nose I think the issue is that his nose is conjested making him breath through his mouth. He is ok for the eve shift so long as he's up once he lays down. I'll check the sensor conections to I didn't think of that, thanks. You are all great being in. Homecare on the overnight their isn't anyone to ask or call unless it's an emergency it's awsome to have a think tank to turn to.

Livi's_mama
05-06-2009, 12:53 AM
Ours would do this because of her leak.

Take it off(the trach), hold it in one hand, use your other hand to cover it....cover it for a sec, remove, cover it for a sec, remove...do it a few times and it'll pop back down to regular instead of the high pitched cycling.

Jacob's Mom
05-06-2009, 05:53 AM
Adjusting the sensitivity has also helped us with this problem. My son sleeps (most of the time) with his mouth open, and that triggers the cycling.