Casey's Current Medical Regime...

Casey has been using the LTV-900 since March of 2001.  Before that he used the cumbersome LP-10.   At first we were using the SIMV mode.  We (and the doctors) thought that since this machine was capable of using that mode, it would be appropriate for him.  When we went for our first official Dr Bach/Lou visit, (August of 2001)  they noted that we were underventilating him and that he should be on volume delivery, not SIMV mode.  (more on that later). 

So, he is on a Volume of 350 ml.   We learned from that visit that we could give him sighs using the vent.  We gradually started giving him bigger volumes for several breaths, to open up his lungs and reach the parts that don't get expanded from the normal volume delivery.  We now give him sighs of 600 ml, in a perfect world, every hour.  (we give him sighs because he can't yawn and take in a big breath like we do, so we up the volume so he can get the benefit of his lungs getting stretched and opened up more.

We use the in/exsufflator at least every nursing shift, about 3 times a day.   He is currently at pressures of +40 and -40.  We use the in/ex as a way to expand his lungs even if he is clear.  Of course, if we think he has "stuff" in his trach, we use it to try to get it up and out without suctioning, or at least with minimal suctioning.   When Casey is sick, we use the in/ex maybe a hundred times a day!  It really helped him this winter (2001) when he had a doozy of a cold.  The previous winter we did not have the in/ex.   We were pulling up large, yucky, bloody plugs--not this year!  This year we got lots of the goop out with the in/ex.  It sure saved him a lot of trauma to his trach.   It's really easy to use the in/ex with a trach.  The hose hooks right to the trach with an adaptor.  Casey doesn't have to cooperate, it just does it for him.  It is so cool to see his chest expand and fall, expand and fall.  It feels good to him and he loves it!  He makes really loud noises when we use it and most of the time he blinks for more!

Casey has lots of oral secretions.   For several years now he has been using Robinul, glycopyrolate, to reduce them.