Non-invasive Open Ventilation

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Linda Melchor

I have been in the respiratory therapy field for over 30 years. I have worked as a staff therapist, clinical educator, and manager. I worked in all aspects of respiratory therapy from critical care staff therapist, nicu transport team, to air ambulance. My passion is teaching and organizing lecture series. In my off hours, you can find me at comic-con.

The Pre-brief

As a home care respiratory therapist, I took care of a gentleman with COPD and End-Stage lung cancer. Upon exacerbation, he could barely breathe.  I placed him on the Life 2000, which uses an interface that resembles a Nasal CPAP.  While wearing this, the patient stated that he was able to breathe a bit more comfortably and that it was the first time in 4 years that he could walk around his house and not feel short of breath. 

What is the Life 2000?

Life 2000 is a lightweight, portable, non-invasive ventilator that offers mask-free support.  It can be stationary or used with an oxygen tank for portability.  It is based on Non-invasive open ventilation.  Non-invasive open ventilation is meant to provide support for those patients with, but not limited to:

  • COPD
  • Mild to moderate hypercapneic and/or hypoxic respiratory distress 
  • ALS
  • HFNC dependency awaiting hospital discharge 
  • BiPAP dependency 
  • Lung cancer with oxygen dependency

How it works 

Let’s talk about the mechanics.  A 50 PSI source such as wall oxygen, an oxygen cylinder, or the compressor that it comes with the unit provides the driving pressure. It ventilates on Assist Control mode, delivers positive inspiratory pressure, and supplements oxygen to augment a tidal volume.  Ventilation is variable depending on activity level; therefore, there are three different tidal volume settings for the patient: 

  1. Resting VT is usually set between 120ml to 150ml with a rate of 12 and I-time of .75 to 1 sec.
  2. Moderate activity VT is set around 150ml to 180ml.
  3. Exertion activity level VT can be set up to 200ml and increased as needed. 
  4. PEEP can be set up to 10, patient dependent.
  5. Maximum positive inspiratory pressure is 40cmH2O.

The interface

Nasal pillows can be used as the interface. The interface has air entrainment ports where the venturi effect allows for additional flow due to increases in patient demands. There are also two sensor ports that will help synchronize with the patient’s efforts.

Non-invasive open ventilation and COPD

Since this gentleman, I have used the device on many more patients and have been able to free them from HFNC and BiPAP.  What is nice about non-invasive open ventilation is that it can be used at home.  COPD can significantly impact ADL’s, as I witnessed from my first patient. Pulmonary rehabilitation is shown to improve health-related quality of life. However, with COPD, even moderate activity can be challenging. In 2012 a study by Porszasz et al. was done concluding that non-invasive open ventilation improves dyspnea, oxygenation, walking distance, and ADLs.

The Debrief

  • A reduction in hospital readmissions could possibly be decreased with increased use of NIOV
  • NIOV can improve quality of life and ADLs in qualifying diseased patients
  • Pulmonary Rehabilitation can improve the quality of life in patients with lung diseases

References

  1. Hill-rom.  Life2000 Ventilators.  https://respiratorycare.hill-rom.com/globalassets/media/product-media/life2000/acute-care-PDFs/211566-en-r1_life2000_clinical-summaries_brochure-lr2.pdf
  2. Porszasz J.,  Cao R.,  Morishige R.,  Eykern LA.,  Stenzler A.,  Casaburi R.  Physiologic Effects of an Ambulatory Ventilation System in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2013;188(3):334-342.  doi:http://ex.doi.org/10.1164/rccm.201210-1773OC

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