USING TRILOGY 202 FOR · 2020-03-26 · PROGRAMMING OF TRILOGY 202 VENTILATORS FOR INVASIVE...

March 2020

K.Dalton - CCOT

USING TRILOGY 202 FOR INVASIVE

VENTILATION

USING TRILOGY 202 VENTILATORS FOR INVASIVE VENTILATION

• ED prompt card


• 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.

• INVASIVE modes : pressure controlled (PC, PC-SIMV) and volume controlled (CV, AC and SIMV).

• 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.

EQUIPMENT AND SET UP OF TRILOGY 202 FOR INVASIVE VENTILATION

Intersurgical circuit ‘passive*’ REF: 5804011 / 5804000 Filter REF: 1544000

Philips Respironics circuit ‘passive*’ REF:1065832 Filter REF: 342077 (REMOVE EXTRA TUBING and cap off)

*passive circuit = single limb, uses expiratory port to remove CO2.

Trilogy 202 Bacterial

Filter Expiratory port

tubing

Attach to etCO2, HME & patient ET tube

Trilogy 202

Bacterial Filter Expiratory

port

tubing


For both systems, use etCO2 and HME filter on ET catheter mount as per standard practice.

Extra (2nd) expiratory filter not

required if using with HME filter.


• Video set-up: soon to be available via iris – see link on microguide


CLEANING FOR TRILOGY 202 VENTILATORS FOR INVASIVE VENTILATION

1. Clean machine and stand before and after patient use with decontamination wipes

2. Filters: single patient use change every 24 hours or earlier if wet/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.

Trilogy 202

Bacterial Filter Expiratory

port

tubing


100% O2

PROGRAMMING TRILOGY 202 VENTILATORS FOR 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 INVASIVE VENTILATION; PRESSURE and VOLUME modes

Invasive PRESSURE modes: PC – Pressure controlled Assist and mandatory breaths. Fixed inspiratory time. SET: IPAP. EPAP. Breath Rate. Inspiratory Time. PC-SIMV – Pressure control synchronized intermittent mandatory ventilation Spont, assist and mandatory breaths. Mandatory breaths delivered if patient does not trigger a breath within a time window. Spont or Assist breaths delivered if a patient does trigger. Mandatory/assist breaths use PEEP and Inspiratory pressure. Spont breaths use PEEP and Pressure Support (Above PEEP). SET: Inspiratory Pressure. PEEP. Pressure Support (Above PEEP). Breath Rate. Inspiratory Time.

Invasive VOLUME modes: CV – Control Ventilation Only mandatory breaths. Patient CANNOT trigger. Fixed inspiratory time. SET: Tidal Volume. Breath Rate. Inspiratory Time. PEEP. AC – Assist controlled Assist and mandatory breaths. Fixed inspiratory time. SET: Tidal Volume. Breath Rate. Inspiratory Time. PEEP. SIMV – Synchronized intermittent mandatory ventilation Volume and Pressure control. Spont, assist and mandatory breaths. Mandatory/Assist breaths deliver set Tidal Volume and set PEEP. Spont breaths deliver Pressure Support (Above PEEP) and PEEP. SET: Tidal Volume. Breath Rate. Inspiratory Time. Pressure Support (Above PEEP). PEEP.

Settings must be determined by a competent clinician, seek help from ICU/Anaesthetics if unsure.

PROGRAMMING TRILOGY 202 VENTILATORS FOR INVASIVE VENTILATION

• Video programming: (link pending)

PROGRAMMING OF TRILOGY 202 VENTILATORS FOR INVASIVE VENTILATION : PC-SIMV MODE

Setting: Initial value

Comments

Dual Prescription

OFF

Dual Prescription allows separate day and night prescriptions for the patient, not used acutely.

Mode

PC-SIMV Pressure Control – synchronised intermittent mandatory ventilation.

Circuit Type Passive Single limb circuit with expiratory port Inspiratory Pressure

25 As per by senior Clinican – for mandatory/assist breaths

PEEP 5

As per by senior Clinician – for all breaths

Pressure Support (Above PEEP)

20 As per by senior Clinican – for spontaneous breaths

Breath Rate

20 Rate delivered if patient is not triggering spontaneous breaths.

Inspiratory time

1.0

For mandatory/assist breaths. (Minimum 1 sec)

FiO2

Start 100 %

Wean as required - aim target sats or paO2 as per senior clinician

Trigger Type

Flow Trigger

The amount of flow required for a patient to trigger a spontaneous breath. Can be adjusted for complex patients, needs senior review.

Flow Trigger Sensitivity

5.0 L/min Can be adjusted for complex patients, needs senior review. E.g. if the patient is weak or not synchronising. 4 L/min will trigger breathe with less effort from patient.

Flow Cycle Sensitivity

25% Trigger for expiration on spontaneous breaths. Can be adjusted for complex patients, needs senior review.

Rise Time 2 Time taken at start of inspiration to reach peak pressure. Measured in 0.1 sec (i.e. 2 = 0.2 sec)

Nebulizer enabled

OFF Can use aerogen device with trilogy using specialised equipment from ICU.

Alarm: Suggested value

Comments

Circuit disconnect 10 sec Apnoea OFF Only applicable when

patient is spontaneously breathing.

Low Vte (tidal volume) alarm

200 Depends on patient ideal weight, adjust accordingly

High Vte (tidal volume) alarm

700 Depends on patient ideal weight, adjust accordingly

Low minute volume alarm

4.0 Minute volume = rate x tidal vol.

High minute volume alarm

14.0 Minute volume = rate x tidal vol.

Low respiratory rate alarm

10 Adjust accordingly

High respiratory rate alarm

30 Adjust accordingly

Settings must be determined by a competent clinician,

seek help from ICU/Anaesthetics if unsure.

PROGRAMMING OF TRILOGY 202 VENTILATORS FOR INVASIVE VENTILATION

• Rise Time (PC, PC-SIMV, SIMV) Expressed in 0.1 sec (i.e. Rise time 2 = 0.2 sec). The time it takes to change from expiratory pressure setting (EPAP/PEEP) up to inspiratory pressure setting (IPAP/ Inspiratory Pressure) – Increased rise time = reduced time at maximum pressure in inspiration (Ppeak).

• Trigger type (PC, PC-SIMV, AC, SIMV) Flow trigger. The amount of flow required for a patient to trigger a spontaneous breath Flow trigger sensitivity. Usually start at 5.0L/min. Possible to adjust if the patient is weak or not synchronising. E.g. 4.0 L/min will allow patient to trigger spontaneous breath with less effort. Leak compensation is included for the passive circuit*

Flow cycle sensitivity. Usually start at 25%. As flow decreases in inspiratory phase, machine switches to expiratory phase. Increasing cycle sensitivity % may shorten inspiratory phase.

• Sigh (Volume modes only - CV, AC, SIMV) When ‘ON’ Sigh breath delivers 150% of set tidal volume once every 100 breaths. *passive circuit = single limb, uses expiratory port to remove CO2.

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 ext 62008 • PRH: CCOT bleep 6331 ICU Dr bleep 6010 Anaesthetics bleep 6442 ICU nurse in charge ext 8182


USING TRILOGY 202 FOR · 2020-03-26 · PROGRAMMING OF TRILOGY 202 VENTILATORS FOR INVASIVE...

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