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Thread: New ventilators -- thoughts?

  1. #21
    My thoughts on the Trilogy100 ventilator / respirator after several months of use...

    Features I like:

    Very quiet: it does make a slight "ticking" sound, similar to a clock but less frequent (i.e. it's after each breath). The vent is so quiet that it's as if the manufacturers decided to add the tick so that caregivers and the user would know that the vent is turned on and working. It does have what can be a moderately loud exhale noise with the active vent circuit, which I'll elaborate on more later.

    Very portable: it's small and compact with a nice handle, should it need to be moved. It weighs only 11 pounds per its brochure, however I don't know if that includes the two batteries (I think it does since the batteries are "housed" with the unit).

    Relatively simple: candidly, I thought the LTV950 had way too many features and was not that user friendly. Granted, I didn't test it for very long, but that was my initial impression. I feel that the Trilogy100 has a simple user interface and more than enough options (perhaps too many still -- I loved the simplicity of my old LP-10 machines which I used for roughly 15 years, and wish someone would design a modern vent to function as simply as the LP-10).

    Single-limb vent circuit: I use their active circuit without a water trap. It's the most like the LP-10 circuit that I loved, i.e. it's simple, single-limb, and that's about it. The LTV950 had me using a double-limb circuit which I felt added more tubing than necessary, plus it was fairly stiff, which I felt could put added pressure on my trach stoma in particular. That said, it takes a couple days for the Trilogy circuits to become nicely flexible; i.e. they are a bit stiff coming out of the package. But they are super easy to change, having the two small tubes securely attached to the large tube and having all three tubes at the proper length (the smaller tubes on the LP-10 circuits I used were shorter than the primary tube, which didn't make sense to me).

    Alarm sound: the alarm is relatively subtle compared to other vent alarms that I've heard. This could be good or not-so-good depending on the vent user. The Trilogy100 alarm kind of "chirps" at your desired volume, and briefly pauses (about 5 seconds) after a double-chirp before doing another double-chirp. It does not give the rapid-alarming "sense of urgency" that some vent users may prefer. I learned to use my neck muscles to breathe some on my own, so I don't feel the need for urgent assistance, so I like that the alarm will alert my caregivers, but not potentially scare the daylights out of anyone else nearby.

    Alarm function: I must say that I thought the LP-10's alarms were designed perfectly, and I specifically mean how the high-pressure alarm would sound immediately if high-pressure was registered, but that the audio alarm would stop once the pressure returned to the normal range. I thought that was brilliant because, once the pressure is normal again, it indicates that the user is safely getting ventilated again. Conversely, the low pressure situation is more dangerous because that typically indicates the vent is disconnected, and if the tubing happened to be disconnected but somehow meeting enough resistance to be in the normal range, then the user might not be getting air and the alarm could be not-sounding.

    For example, if the vent circuit "popped off" in bed and somehow managed to have the disconnected end be fairly firm against the bedding, in theory, it might not continue to alarm if it met enough resistance for the pressure to return to normal. In practice, we could not get the low pressure alarm to not sound, even when held tightly to a blanket, but users should test "pop off" scenarios to ensure their vent alarm will sound.

    Anyway, I liked that the LP-10's low pressure alarm would continue to sound until reset, because as described previously, the low pressure situation is potentially more dangerous than the high pressure situation (high pressure could mean that the tubing is pinched or perhaps secretions are not enabling good airflow through the trach, but once the pressure is back to normal, the user should be getting good airflow).

    But I have slightly changed my mind about the low pressure alarm, especially in my situation since I can breathe some. The Trilogy100 is set to have the alarm stop sounding once the pressure returns to normal, even from low pressure. In a practical sense, this is handy for when my caregivers are dressing me or using the CoughAssist (a suctioning alternative) or giving me a saline bullet. All are non-pop-off scenarios, and the LP-10 alarm would keep sounding once the vent was removed, and until the alarm was silenced after the vent was reattached. The Trilogy100 will silence the alarm itself once it is successfully reattached. I wasn't sure that I would like that, but I do.

    Battery charging: the batteries charge fairly quickly and simply by being plugged in via a standard cord to a standard outlet. I don't remember exactly how the LTV950 charged, but it was definitely more complicated than how the Trilogy100 charges (i.e. I think the LTV950 required keeping a detachable "charging cord" with the vent).

    Lighted display: I didn't even know that the display was lighted until the lights were off in my room and someone told me the display was lighted. But I like that because it's a nice safety feature both inside and outside when dark, i.e. someone is less likely to bump into me inside with it lighted, and more importantly, if I'm outside at night and potentially on or near a street, cars should be able to see the vent and hopefully avoid me!

    Features I am "so-so" about:

    Lighted display:
    I just listed this under things I like, however, for going to movies, I will plan to have the display covered as it does put out a fair amount of light and I don't want to aggravate other moviegoers, who rightly are paying for the experience of watching the movie in a dark theater. But covering it should be quite easy.

    EDIT: Respironics (Philips Healthcare) Senior Global Product Manager said the vent has a "screen saver" option that might suffice. It also allows the brightness to be adjusted, but our initial "playing" with those options did not seem to change much. Maybe we'll try it on my bedside vent when I'm in my chair so that I can understand the options better and potentially help my caregiver(s).

    Battery life: the Trilogy100 comes with two enclosed batteries -- a 3-hour detachable battery, and a 3-hour internal battery. A battery cable is an accessory one can order that should allow one's wheelchair batteries to power the vent "all day long" (over 12 hours with ease, I'm told) but I haven't been able to test that yet. Six hours of battery life isn't great, but as noted previously, they seem to charge pretty quickly and easily, and battery life could be fantastic once it's attached to my wheelchair batteries.

    Active vent circuit: I really don't know the difference between an active circuit and passive circuit, however my RT said this should function the most like my old LP-10. But what I find interesting is the active circuit has an exhale, even with a speaking valve (PMV) inline. With the LP-10 circuit, there was no exhale when using a PMV because the PMV would not allow any air to be exhaled out of the vent circuit. I don't know if it's related to the pressure support provided by the Trilogy100 but even with a PMV, a fairly loud exhale occurs from the circuit with each breath given.

    Things I wish Respironics would improve:

    (The Trilogy100 has software which my RT updated, so perhaps Respironics (the manufacturer) could actually address some of the functionality with a future update.)

    Initiating breaths without stacking: this is where I most miss my LP-10. I used the SIMV setting on the LP-10 and could pretty easily initiate additional breaths (before the scheduled breath) by slightly pulling my chest up with my neck muscles, and the way my LP-10 was set, it never stacked breaths -- stacking means it's delivering extra breath(s) more quickly than scheduled, without me initiating the extra breath(s). Stacking is uncomfortable and could lead to hyperventilation. When I first tried the Trilogy100, it stacked many breaths, and I think I was getting too much air, which dried out my airway and likely contributed to a bleeding issue.

    We tried a bunch of different settings and have reduced the amount of stacking that the vent does. It doesn't stack very often anymore. Interestingly, it never stacked when I was tilted all the way back in my chair, even before we improved the settings. However, I did routinely setoff the apnea alarm (I think that's what it was) when tilted back -- and only when tilted back. I actually had my RT turn that alarm off completely (the circuit disconnect alarm, low pressure, and high pressure are all still operational). Also, although it doesn't stack very often on my current settings, I find it interesting that when it does, it's usually within 30 minutes of getting in my chair. It seems to not happen after roughly 30 minutes, until some occasional idle moments when I'm not talking or doing anything. It's kind of hard to explain and I don't know why the stacking occurs.

    Wheelchair attachment method: Respironics does NOT make any type of wheelchair attachment method for the Trilogy ventilators (in addition to the Trilogy100, they have a new Trilogy200). Respironics has an "in use" carry bag, but that's not designed to attach to a wheelchair. I actually contacted Respironics and they said the below two vendors (with whom they have no affiliation) are the available options:

    http://www.richardsonproducts.com/TrilogyVC.pdf

    http://www.freedomvent.com/respronics.html

    I'm getting a new wheelchair and have asked my wheelchair guy which of the above two options he thinks would be best.

    IMPORTANT EDIT: I initially thought that the alarm silence button was dangerous (that it wouldn't reset automatically) but that's because we removed my vent circuit within a minute of having silenced the button (to test it, we removed the circuit, silenced the alarm, attached the circuit to me again, waited about 10 seconds, and removed the circuit again -- and the vent didn't alarm). But I received a reply from Respironics (Philips Healthcare) Senior Global Product Manager regarding my review of the Trilogy100 and he said that the alarm will automatically reset itself after one minute.

    I should've known that they wouldn't put a vent on the market with an alarm that wouldn't reset automatically, but it didn't come with a user guide, so all I could go on was our test (described above) which was less than a minute. We tested this and it does indeed reset automatically after a minute.

    That essentially concludes my thoughts to this point regarding the Trilogy100.

    Bill Miller
    Last edited by BillMiller823; 10-20-2012 at 03:53 AM.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

  2. #22
    Quote Originally Posted by BillMiller823 View Post
    Things I wish Respironics would improve:

    Wheelchair attachment method: Respironics does NOT make any type of wheelchair attachment method for the Trilogy ventilators (in addition to the Trilogy100, they have a new Trilogy200). Respironics has an "in use" carry bag, but that's not designed to attach to a wheelchair. I actually contacted Respironics and they said the below two vendors (with whom they have no affiliation) are the available options:

    http://www.richardsonproducts.com/TrilogyVC.pdf

    http://www.freedomvent.com/respronics.html

    I'm getting a new wheelchair and have asked my wheelchair guy which of the above two options he thinks would be best.

    That essentially concludes my thoughts to this point regarding the Trilogy100.

    Bill Miller
    Thanks for posting.

    I'm actually dealing with this very same issue right now. It will be more challenging to mount the Trilogy in a user friendly way on a powerchair given its physical dimensions (compared to the LTV). I'll be collaborating with Permobil on a solution (it's for an existing powerchair).

    Stay tuned.


  3. #23
    Thanks for the report Bill. The less alarming alarm would be nice.

  4. #24
    The Trilogy100 alarm kind of "chirps" at your desired volume, and briefly pauses (about 5 seconds) after a double-chirp before doing another double-chirp. It does not give the rapid-alarming "sense of urgency" that some vent users may prefer.
    I'm supposed to be trying out the Trilogy (if my doctor ever gets it together to write the letter of medical necessity which should have been done a month ago) and this part does worry me. Sounds great for daytime use, but can this non-urgent alarm be set loud enough to wake a sleeping caregiver?

  5. #25
    Quote Originally Posted by SCI_OTR View Post
    Thanks for posting.

    I'm actually dealing with this very same issue right now. It will be more challenging to mount the Trilogy in a user friendly way on a powerchair given its physical dimensions (compared to the LTV). I'll be collaborating with Permobil on a solution (it's for an existing powerchair).

    Stay tuned.
    SCI_OTR, I'm quite interested in your collaboration with Permobil as my new chair is going to be a Permobil C500 VS.

    Thanks.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

  6. #26
    Quote Originally Posted by LindaT View Post
    Thanks for the report Bill. The less alarming alarm would be nice.
    LindaT, since your husband Dave can breathe pretty well without the vent, then I agree. However, if someone cannot breathe at all without the vent, something I forgot to mention above could be VITALLY important -- until it's fixed...

    I accidentally forgot to mention the BIGGEST PROBLEM with the Trilogy100 -- and it could be EXTREMELY IMPORTANT.

    The alarm silence button is DANGEROUS! If the vent is off me and the alarm silence button is hit, the alarm goes quiet as it should. However -- the HUGE PROBLEM is that once the vent is back on me and working normally -- the alarm WILL NOT SOUND unless a caregiver remembered to hit "reset" after the vent is reattached. To be clear, the next time the vent circuit comes off me, the alarm will NOT sound unless the vent was reset. That could be fatal!

    Our temporary remedy for the dangerous alarm silence button is to simply not use it. The "chirping" noise the alarm makes is not ridiculously annoying, so we let it alarm when it's not connected to me. But, seriously, the flaw that Respironics needs to fix (and I think they can with a software update) is to have the alarm silence button automatically reset itself once the vent is reattached.

    I have two contacts at Respironics and will be sending them this info later today.

    IMPORTANT EDIT: I initially thought that the alarm silence button was dangerous (that it wouldn't reset automatically) but that's because we removed my vent circuit within a minute of having silenced the button (to test it, we removed the circuit, silenced the alarm, attached the circuit to me again, waited about 10 seconds, and removed the circuit again -- and the vent didn't alarm). But I received a reply from Respironics (Philips Healthcare) Senior Global Product Manager regarding my review of the Trilogy100 and he said that the alarm will automatically reset itself after one minute.

    I should've known that they wouldn't put a vent on the market with an alarm that wouldn't reset automatically, but it didn't come with a user guide, so all I could go on was our test (described above) which was less than a minute. We tested this and it does indeed reset automatically after a minute.
    Last edited by BillMiller823; 10-20-2012 at 03:57 AM.
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

  7. #27
    Quote Originally Posted by Soliloquy View Post
    I'm supposed to be trying out the Trilogy (if my doctor ever gets it together to write the letter of medical necessity which should have been done a month ago) and this part does worry me. Sounds great for daytime use, but can this non-urgent alarm be set loud enough to wake a sleeping caregiver?
    Soliloquy, good question, and I believe the answer is yes. In fact, my caregiver is currently sleeping on a bed next to me. I feel confident he will wake-up if the alarm goes off (I believe he has previously, and he's a pretty deep sleeper; light sleepers will most definitely awaken). At the maximum volume, it's certainly not quiet, it's just less annoying than some vent alarms.

    Do you have Skype? I'd be happy to Skype with you so you could hear what it sounds like yourself. Either that, or around Christmas, I want to make a CoughAssist demo video, and the alarm will be heard while I'm disconnected.
    Last edited by BillMiller823; 10-17-2012 at 01:30 AM. Reason: Added "at the maximum volume" above
    Wheelchair users -- even high-level quads... WANNA BOWL?

    I'm a C1-2 with a legit 255 high bowling game.

  8. #28
    Quote Originally Posted by BillMiller823 View Post
    SCI_OTR, I'm quite interested in your collaboration with Permobil as my new chair is going to be a Permobil C500 VS.

    Thanks.
    I wlll be sure to point that out since it helps to demonstrate whatever solution we come up with will likely be needed by others in the future.

    I am trying to do a Trology 100 version of this C300 (including the PowerTech Vent Center and E size O2 cylinder)

    http://sci.rutgers.edu/forum/showthread.php?t=186860.



  9. #29
    The alarm silence button is DANGEROUS!
    I sure hope they can solve that with a firmware update, because that is an accident waiting to happen.

    SCI_OTR, I heard the company was going to discontinue the PLV line of ventilators (not just manufacture but support and service as well) at the end of the year. Many people will be needing a wheelchair mounting solution.
    Last edited by Soliloquy; 10-17-2012 at 01:55 PM.

  10. #30
    Quote Originally Posted by BillMiller823 View Post
    SCI_OTR, I'm quite interested in your collaboration with Permobil as my new chair is going to be a Permobil C500 VS.

    Thanks.
    Quote Originally Posted by Soliloquy View Post
    SCI_OTR, I heard the company was going to discontinue the PLV line of ventilators (not just manufacture but support and service as well) at the end of the year. Many people will be needing a wheelchair mounting solution.
    Maybe the recent "cardboard wheelchair" thread got to me. This is the first time I've ever posted anything fabricated from cardboard. The box is roughly the same dimensions as a Trilogy 100.

    These are pics of a mock up I will be sharing with Permobil tomorrow to provide some idea of what I am looking for in a vent tray for the Trilogy 100 on their Corpus 3G seating. It will be for this specific chair. Our facility uses the LTV series of vents, but this particular user will be receiving the Trilogy 100 and Permobil's compact vent tray is just a bit to small.







    Vent trays equipped powerchairs represent a very small part of the market and we have at least two people who are vent users actively following the most-recent posts in this thread. If, by chance, the people at Permobil happen to "discover" this thread, does anyone have any thoughts about features they might want to see in a Trilogy 100 vent tray for Corpus 3G seating?


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