Anyone out there work with the Babylog much? I am concerned with the amount of tube obstruction alarms. Any suggestions. On occassion the problem is evidently related to the child strutting against the device. On occassion the problem is related to water on the flow sensor. But it rings all the time for no apparent reason. HELP. haha. Seriously though any thoughts?
I am not at work, but off for a few more days.
I am not a Babylog expert by any stretch. We have a Level 2 Nursery and use the Babylog, not super often at all though.
However I did draw up a lot of the competencies and training material.
There is some test procedure we have when we change circuits. I don't have it handy. When/if you do such a ritual does the Tube Obstruction alarm sound much? If it doesn't then it must be something involving either baby/circuit/mode interaction and/or water.
Could it be water in exh block or (if you use) exp filters?
Does this happen with a lot of patient types and modes? Or is there a typical scenario in which it occurs (or is worse?).
If you are using Volume Guarantee could it be that the patient wants more VT and therefore "struts" against the device?
Is your humidity too "active"? Water on the flow sensor shouldn't cause that particular alarm should it? Maybe interfere with volume measurement (and Pressure target in VG mode).
Always glad to get a response from you.
As far as patient population it really does seem to happen with the smaller kilo babies which require 2.0-2.5 tubes. The resistance is likely the issue there. The more active the baby the more likely the tube obstruction alarm. This particular case is in fact becoming more and more apparent to be due to strutting. This patient bares down often and demonstrates several neurologic symptoms. Sedation has been increased and the alarms have reduced in frequency. Still occurs though. Incidently when this does occur there is often a long pause in ventilation. Of course being a pressure vent it goes along as perscribed, however there is no actual movement of alveolar gas until after the "freezing" of the chest has stopped. Frustrating beyond belief. We have taken numerous steps to circumvent this issue.
Duing the last post I had also noted a large leak which does seem to increase the likelihood of these alarms. It also makes it difficult to help the child recover.
Initially I wanted to blame the flow sensor, and began working back from the patient. I started by positioning, advancing a catheter, and ensuring the tube hadn't become dislodged. I then moved to the circuit ensuring the neoflow sensor had be calibrated and was not gobbed with H20 Or something more opaque. Then to the tubing.
Changing modes didn't make a whole lot of difference in frequency of this alarm but it did help to be on a pressure mode when dealing with large leak and trying to maintain VG.
Anyway it is 110am and I am doubtful that anything I am say is of a lot of value.
Greetings and thanks for your response.
Just got this from Dennis Bing (Drager). I've seen him talk about PSV/VG at a conference, met him at vendor displays, etc.
I apologize for my tardy response. I will answer as best I can.
The "Tube Obstructed" alarm on the Draeger Babylog 8000 plus ventilator is activated when the device senses pressure at the proximal airway, but sees no inspiratory or expiratory flow for one complete ventilator cycle (Tinsp + Texp). Other than the obvious obstruction in the ET tube, other situations may spuriously cause this alarm. For example, an agitated infant who is breathing asynchronously with the ventilator cycles, in modes with a set, fixed inspiratory time, may also trigger this alarm. I have occasionally observed this alarm in the circumstance of excessively high inspiratory flow rates, in combination with small ID ET and trach tubes, where the flow through the proximal airway flow sensor is highly turbulent.
You may post my response, but with the disclaimer, "The opinions expressed here are my own, and are not official communications of my employer."
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