using trilogy 202 for non-invasive · for non-invasive ventilation • philips recommend that the...

March 2020

K.Dalton - CCOT

USING TRILOGY 202 FOR NON-INVASIVE

VENTILATION

USING TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION

• ED prompt cards…

• Use BSUH infonet for NIV (BiPAP) or CPAP monitoring documentation.


• 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.

• Non-Invasive Modes:

• S/T = BiPAP

• CPAP

• 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.


Trilogy 202

Bacterial Filter

Expiratory port

tubing

Additional Bacterial

Filter

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

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

SETTING UP OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION

Trilogy 202 Bacterial

Filter Expiratory port

Attach to patient

NIV mask

Attach to patient

NIV mask.

tubing

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

SETTING UP OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION

Trilogy 202

Bacterial Filter

Expiratory port

tubing

Additional Bacterial

Filter

CLEANING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION

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

2. Filter: single patient use change every 24 hours or earlier if 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. Attach to patient

NIV mask / hood.

100% O2

PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-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


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

Non-Invasive Modes: S/T – Spontaneous/Timed ‘BiPAP’ Spont breaths with mandatory (‘back –up’) breaths. Spont breath duration including I:E is determined by patient. Mandatory breaths - uses set inspiratory time and breath rate, only delivered if the patient does not trigger. SET: IPAP. EPAP. Breath Rate. Inspiratory Time.

CPAP – Continuous Positive Airway Pressure Only spont breaths. Continuous pressure delivered. ‘Flex’ refers to a comfort feature which slightly reduces pressure delivered during expiration phase. SET: CPAP, flex.

PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION MODES

BiPAP (NIV) Setting: Initial

value Comments

Dual Prescription

OFF

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

Mode

S/T Spontaneous and timed. Display shows ‘Passive S/T’

AVAPS OFF Average volume assured pressure support – not used for BiPAP.

IPAP Start at 15

Aim 20. Increase if pCO2 not falling. Increase by 2 up to max 30.

EPAP start at 4

Can increase - Senior review required.

Breath Rate

10 Only for backup breaths, if patient is not triggering.

Inspiratory time

e.g 1.5

Only for backup breaths, if patient is not triggering.

FiO2

21 – 100 %

Aim target sats (usually 88-92%) Start at requirement prior to BiPAP starting (e.g. 35%)

Trigger Type

Auto-trak

Can be adjusted for complex patients, needs senior review.

Rise Time

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

Ramp

OFF

Nebulizer enabled

OFF Can use aeronebs attachment using additional equipment.

Setting: Initial value

Comments

Dual Prescription

OFF

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

Mode

CPAP Continuous positive airway pressure.

Circuit Type

Passive

Single limb circuit with expiratory port

Flex OFF Can set to 1 or 2 to reduce pressure in expiration phase.

CPAP start at 5

Increase as required - Senior review required.

FiO2

100 % Start high and wean down – As required. Aim for target sats or paO2 as per senior clinician.

Ramp

OFF

Nebulizer enabled

OFF Can use aeronebs attachment using additional equipment.

CPAP

Settings must be determined by a competent clinician, seek help from

ICU/Anaesthetics if unsure.

• Video programming: (link pending)

PROGRAMMING OF TRILOGY 202 VENTILATORS FOR NON-INVASIVE VENTILATION MODES


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

Rise Time (S/T) Expressed in 0.1 sec (i.e. Rise time 2 = 0.2 sec). The time it takes to change from expiratory pressure setting (EPAP) up to inspiratory pressure setting (IPAP) – Increased rise time = reduced time at maximum pressure in inspiration (Ppeak) but may be more comfortable and improve patient synchronisation. Trigger type (S/T) Usually set at ‘AutoTrack’. Determines how sensitive the machine is to detecting the patient’s breathing effort, sensitivity may be increased if RR is low (adjust to AutoTrack[Sensitive]). If RR is high, confirm that correct trigger type is set.

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


using trilogy 202 for non-invasive · for non-invasive ventilation • philips recommend that the...

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