respiratory rate? air leak with vent?

Caleb'sMom · #1 05-20-2011, 10:22 AM

a few questions:

1. How fast do/did your kids breath at 8 months?
Caleb is always in the 70s when awake...which is actually a big improvement for him from before he had the vent...but it's still quick...so just curious

2. he in vented 24/7 with a peep of 6 only. no O2. he has a pretty big air leak- he can make tons of loud noise around his trach. we love this!! BUT...at what point is his vent support basically ineffective with a big leak like this...i often hear him breathing in and out of his nose

3. bc of this air leak, if he's doing fine otherwise, would they keep him at a 3.5 or up him to a 4.0 as he gets older....are kids usually upsized as they grow if they aren't close to decan?

clearly these are ?s i will take up with my pulmo and ENT but wanted to rack the experts on here

Sweet Harrison's mommy · #2 05-20-2011, 10:47 AM

1.Harrison is 6.5 months, but he also breathes on the fast side when he is awake and active. 60's and 70's. Now, he is off of the vent when awake and still breathes fast at times. What is Caleb's respiratory rate when he is in a deep sleep? Our Respiratory Therapist said to pay more attention to that number.
2. When on the vent, Harrison also has a pretty big air leak and he can make noises around the trach. He has a 3.5 and probably needs bigger. Again, our RT told us that compensating with the nose and mouth can be a good thing, as long as he is not struggling....no flaring, retracting, etc. It can be a sign that he is getting stronger and is needing less support.

Alex's mom · #3 05-20-2011, 11:37 AM

My daughter is 5 and vent dependant. She has a bronchoscopy once or twice a year and her trach size is adjusted depending on what the ent decides based on measurements during each scope.

She has a pretty good leak as well. It was decided last year that we would use a cuffed trach and inflate the cuff during sleep to help the vent better support her. We deflate the cuff during the day.

RylanDakota · #4 05-20-2011, 11:37 AM

Rylan was a fast breather too 60's-70's. She has a 3.0 with a HUGE leak and they upsized her a year ago to a 3.5, which she hated because she couldn't make noise anymore, so we went back to the 3.0.

kadiera · #5 05-20-2011, 12:12 PM

My suspicion is that in many cases they won't upsize just to upsize - they'll judge based on sats, respirations, CO2, and so on.

Alexander was upsized to a 4.0 before we left the NICU - I want to say he was 7 or 8 months actual, which would have been 4-5 months adjusted...largely because the hospital ventilator couldn't compensate for the huge air leak (and snoring) he did with a 3.5. By the time we started weaning him off the vent around 15 months of age, he could easily make noise around the vent, and tolerated a PMV with a hole drilled in it. He's nearly 3 now and has been ventilated during surgery with his current 3.0 trach - I don't know that he could be ventilated long-term that way, but clearly, it's sufficient for surgery at this point, with a really huge leak.

I think Alexander's respirations were in the 50s mostly back when he was little and on the vent....except in deep sleep, when he rode the vent at exactly 20.

Caleb'sMom · #6 05-20-2011, 06:42 PM

so do a lot of vented kids tolerate a PMV during hours off the vent...or is it usually HME...then PMV later?

Sweet Harrison's mommy · #7 05-20-2011, 11:43 PM

Honestly, Harrison does not like either one!! He prefers for his trach to be left uncovered. Not a good habit to form! But, he tolerates the HME for much longer periods of time than the passy. we are attempting to train him to tolerate the passy for longer periods, but for now, most of the time he wears his HME.
From what I've been told, every kid is different. Some tolerate the Passy right away with no problem, while others take a longer time adjusting.

lilwedwritinghood · #8 05-21-2011, 12:13 AM

Our Ent said that he routinely upsizes at around one year, which I thought was odd, but I think it is normally based on, like others have said, how well they are being ventilated. That is determined by o2,co2, etc. When Nicolas was upsized at one year from a 3.0 neo to a 3.5 ped he lost all of his ability to vocalize. He is just recently starting to make little noises again at 21 months! Just the other night as he slept I heard a weird noise and went to check on him and realized there was air coming out of his nose. It was quite cute so hopefully it isn't a bad thing!

One great thing that came out of the upsize was his decrease in frequency of suctioning. We were having to suction about every 5 minutes and once upsized it went to once every half an hour or so. Until recently of course with whatever this is we are battling!

kadiera · #9 05-21-2011, 07:26 AM

Quote:

Originally Posted by Caleb'sMom

so do a lot of vented kids tolerate a PMV during hours off the vent...or is it usually HME...then PMV later?

We couldn't convince anyone to give us a PMV to try until Alexander was off the vent during the day, and then we had to work up to wearing it. Other than that, he wore an HME all the time he was off.

It's another one of those things that totally depends on the size of the air leak - the whole thing with a speaking valve is that it requires a certain amount of leak so that there's enough airflow to go through the vocal cords & mouth & nose.

emily · #10 05-21-2011, 08:04 AM

Luke breathes from 60-80 while awake and he rides his vent at 20 or 30 when he is asleep. Our pulm said that most kids grow out of the fast breathing but like someone else said, that as long as the sleeping rate gets down below 45 or better yet even 40 then things are okay. She wasn't worried.

Luke is able to make noise around his vent as well and they didn't see it as that much of a concern. They never talked about increasing trach size. We have a 4.0

We are weaning Luke off the vent and the ENT said that as soon as he is off the vent we can start decreasing the trach size. He doesn't want to do it before that because he doesn't want to create leaks or more of a leak.