13 Comments
  1. Minh

    Thanks for this post. Have you any thoughts on the use of the NIV setting on the Oxylog 3000 for COPD patients? I’ve had a few problems with the FiO2 lower limit at 0.4 on this machine and was wondering if you had any ingenious solutions for this patient group, with their tendency to retain CO2 when too high an FiO2 is delivered.

    The problem I’ve had relates to not having easy access to a dedicated NIPPY machine when these patients hit the front door and using the NIV setting on the Oxylog as a bridge to a respiratory/HDU bed.

    Any thoughts you have on this clinical problem would be gratefully received.

    Best wishes

    Dr Dean Burns

    • thanks Dean
      no ingenius ideas sorry. Once on CPAP/PS NIV mode, COPD patients generally blow off their CO2 and improve within 60 minutes or less,regardless of FiO2 0.4
      Lowering the trigger limit and uptitrating the PS bit by bit may help alleviate the CO2 retention

  2. The stuff you do is sooo damn good. Yesterday I watched the Oxylog stuff on LITFL, EmCrit and the simulator and I was just missing one thing.
    Now even this is done. I will add it to my post on our German EM website.

    Thank You,
    Lars

  3. Hey guys
    Check out the Hamilton T1 from Hamilton Medical
    Has NIV and NIV-ST
    Peak flows of 240lpm with leak compensation
    Great for high demand patients.

  4. Thanks Minh! I was getting confused. as intuitively I thought you would have to use the Bipap mode to deliver what I understand as “Bipap” NIV. But this mode seems to be more for non-spontaneously breathing patients. Now its clear that you have to use the spn/CPAP mode, and set the pressure support on there, to deliver what I understand as Bipap. Thanks!

  5. Hi Minh, I’m a retrieval/emergency consultant from Lismore and was interested to watch your tutorial as I had a difficult oxylog 3000 NIV case last night in a patient with asthma/copd. For years there was a bit of dogma it seemed about not transferring patients on NIV. It was the concern about oxygen consumption and if the patient deteriorates. So patients ended up intubated which seemed unnecessary much of the time. NIV on the oxylog 3000 not plus we’ve found in our service to be a bit hit and miss. I’ve heard the + is better but experience with the Hamilton T1 makes me wish we’d built a bridge for it.
    Interestingly draeger recommends PCV for NIV as indicated by the bipap label on that button. I would have intuitively thought it should be PS. There is a reason I suspect behind this. In PCV with a background rate it avoids the issue of autotriggering. This is when the ventilator mistakenly gets into a pattern of inappropriately delivering fast small breaths. It’s extremely distressing for the patient and can precipitate rapid deterioration.
    I find a lot of it is fiddling, minimising leak, adjusting settings slightly but frequently until the patient feels comfortable.
    Thanks,
    Andre

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