My dad was diagnosed with ALS in June 06.
At present, he is unconscious after having a respiratory attack.
He is on a ventilator at present and got a trachestomy done 2 weeks back (in unconscious state due to excessive secretions).
My question is??
Is there a bi pap mechanism using a trach.
He cannot get the mask as he does not control his breathing at the moment...
Please help....
Thanks...
G...

Gary,
At this time only the Vision by Respironics is FDA approved BiPAP unit for use with trachs. There are currently no true policies or protocols that cover BiPAP use with trachs.
I know of a few places that are working on them.

there was an ECRI alert recently regarding Bipap Visions as life support. It is a bit of hair splitting but for liability reasons you should have a peek at it.

Hi Gray,

What kind of ventilator is he on ?

If you are using machine like PB840, You can use Pressure Support as a BiPap, by setting you'r PS as IPap, and PEEP as EPap.

First my sympathy for you and your Dad. I apologize for the late reply and imagine things may have changed (hopefully for the better).

You said he is unconscious because of excessive secretions. ? The secretion load must have ushered in some other condition which caused the lack of consciousness (labored breathing and hypoxemia?).

In any event I am going to argue against using the Vision for his ventilatory needs as long as he is trached.

If he ends up using a mask during the day and plugged trache at night then MAYBE the Vision could be set such that the backup rate kicks in, making it PC mode (if breaths aren't patient triggered then they are pressure/time based--if the patient triggers the breath then they are Pressure Support.)

Pressure Support wouldn't be good for a trached patietn whom has secretion issues. The secretions will build up and VT will plummet. This could reach dangerous levels before any alarm goes off. Far better to have a volume based VT delivered. Secretions mount, alarm goes off, patient gets suctioned. A pressure/time breath would be better than PS, but still Volume based would be better.

Also with secretions how would you humidify the airway when there is a leak port? An HME wouldn't get the breathe returned fully to capture the humidity. With the leak active any active humidification will then lead to massive rainout in the circuit, etc.

My suggestion--use an LTV, or that new small Newport. If trached use VC. When/if using mask use PC or NIV mode.

Periodically, if able, do some manuevers to apply some variane to it all. Increase VT a bit, increase/decrease insp time. Increase Peep a bit for a few breaths. Bag ventilate and do some insp holds, quick releases, etc. All to combat atelectasis and work up secretions.

Good luck