Need Advice on Move from PB 840 to LTV 1000

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October 06, 2006, 04:15 AM
Need Advice on Move from PB 840 to LTV 1000

My sister is a cystic fibrosis patient that is now ventilator dependent. She is currently being looked after in an ICU, but they are attempting to force the Palliative Care Unit to accept her.The Palliative Care Team at our hospital does not want to have my sister's comfort compromised. My sister has been on the Puritan Bennett 840 series ventilator since early May 2006 and has just recently been forced to move to the LTV 1000. Her settings on both machines are 10 cm H20 ,40% Oxygen and a pressure assist mode, however she was on 14cm H20 on the LTV1000.

The ICU staff claimed that the move to the LTV 1000 would be problem free however, my sister has had some difficulty in the transition. She describes the new ventilator as being uncomfortable and she is visibly in some distress on the machine. As a CF patient she has a very strong cough and it is important that her secretions clear with ease. She found that the heated humidity on the PB 840 superior to the humidity provided by the inline filter on the LTV 1000.

The ICU staff and the respiratory therapists have been dishonest with my sister in the past. In early September they deceived my sister into trying the PB 7200 and she had a very difficult time on the machine. She could not adjust to the control mode and she had difficulty with her cough. She suffered for sometime on the machine until they deemed that it was not working well with her.

Since we live in Canada, the ICU is not permitted to compromise my sister's health/comfort for monetary reasons. I am asking if anyone could please let me know if there are any significant differences between these two machines?

October 10, 2006, 08:57 AM
<Dave Tolle RRT, RCP (ret)>
Shifting from one brand of ventilator to another can be difficult for patients. In the past we had the same problem changing people using a Drinker type Iron Lung to the easier to maintain Emerson Iron Lung. Although both did adequately support ventilation they did feel different and this causes anxiety for those whose life depends on the machine.

However, in your case you do raise a valid issue. The passive artificial nose type humidifier is not as aggressive as an active thermal one. The noses use exhaled water vapor to re-humidify subsequent delivered breaths while the heated units assure each breath holds the maximum amount of humidity. Cystics do need to keep their mucous liquid and their lung hygiene as pristine as possible. There are active humidifier products which can be used on home/portable systems. To mind comes a
Fisher-Paykel unit but others may well exist.

I do not know the ultimate goal(s) for your sisters care plan. Cystics who've become vent dependent present a difficult scenario. I suggest that you and your sister learn more about these goals and exactly how they're to be approached. Use this site to pose any questions and be as concise and clear with them as possible. You and your sister are at some hard crossroads and I wish both of you the best.
October 13, 2006, 03:15 AM
My sister has accepted the LTV1000 and she seems to be getting used to the noise of the unit. She still prefers the 840 for comfort, but the portability of the LTV1000 is attractive.

Thank you for taking the time to answer my questions.
October 13, 2006, 01:34 PM
I am a RT manager of a long-term vent unit in NC. We use LTV900's. A heater can but put on the LTV 1000 in place of the inline filters, for someone with the secreations that accompany a CF pt., I don't see the reason someone would even consider the inline filter.
October 30, 2006, 08:03 AM
<Angela King, BS, RPFT, RRT-NPS>
Hello. My name is Angela King. I am the Sr. Clinical Director for Pulmonetic Systems. We make the LTV Series Ventilators (including the LTV 1000).

I am sorry your sister is having a hard time. I would be happy to help however I can.

Patients are often transitioned from a big ICU vent (such as the 7200 or 840) to the LTV (which is also a critical care vent). Since the LTV is so much more portable, patients generally like to be on it so they can go on outings. However, there is often an adjustment period switching from one to the other. There are a number of settings that can be adjusted to maximize patient comfort-- unfortunately sometimes it just takes awhile to get everything right.

Another point you mentioned: the LTV is not peep compensated-- so it is appropriate that the settings on the LTV will include the PEEP setting (as you described). This is appropriate.

Humidity can make a huge difference in the patient's comfort, as can some of the "fine tuning" settings. Please feel free to call me if I can be of any help to your family.

Thank you,
Angela King
734 604 8688
November 01, 2006, 03:27 AM

Thanks for your posts in this thread.

My sister has developed a very dry cough and the staff may be willing to look at another option for humidity. Can you please recommend a humidifier that would be effective on the LTV 1000?

Also, is it possible to connect and effectively use a nebulizer on the LTV 1000? We were told that it's not possible for her to be given Pulmozyme on while on the LTV 1000.