The debilitating effects of COPD trapped Jackie in her house for more than two years. She was suffering from chronic hypercapnea, hypertension, anxiety, depression and hypoxemia (treated with long-term oxygen therapy). “I was always so afraid I would have a breathing attack or a panic attack in public. I was just sick and tired of being sick and tired. I missed a few of my children's most important functions and my oldest daughter's graduation from college. It's an awful feeling not being able to breathe.”
Hospitalized multiple times for COPD exacerbations, Jackie presented to the emergency room in October 2011 obtunded but responsive. Arterial blood gases performed on initial presentation were: pH 7.19, PCO2 123.7, PO2 88, HCO3 47.2.
Noninvasive ventilation was initiated and maintained until her arterial blood gases normalized. Her weight was down to 87 lbs. Upon discharge, the focus was on preventing unplanned hospitalizations, improving her quality of sleep, decreasing dyspnea, and improving her overall energy level and quality of life. Her physician ordered noninvasive ventilation. Because of the higher pressure support needed, the Trilogy100 was prescribed. Her settings were ST mode with AVAPS, target VT 460 (8cc/kg ideal weight) IPAP max 36, IPAP min 13, EPAP 8, RR 12.