Jorge Bolano R.R.T, R.C.P – Respiratory Therapist, Home Respiratory Care Provider
Driven to Continually Improve Patient Care and Outcomes
As a respiratory therapist since 1981 and founder of Health Care Solutions Group, Inc. (hcsgi.com) since 2000, Jorge Bolano R.R.T., R.C.P. has crusaded to improve the quality of life for his respiratory patients. He established his company with the commitment to, in his own words “focus on providing better outcomes and delivering the high level of care that the patient needs.” To that end he has had his clinical respiratory care services accredited by the Joint Commission since 2006. Through the years he has seen significant improvement in the quality of care delivery to his patients. The company motto sums up his attitude, “Success is gained in the pursuit of excellence and our success is measured by better patient outcomes.”
Health Care Solutions Group, Inc. specializes in complex respiratory cases with use of high flow therapy systems, invasive and non-invasive ventilators, and assessments in the home for patients’ with diseases that range from neuromuscular illness to COPD.
Jorge’s need for constant improvement led him to the Breas Vivo 65 ventilator. As he describes it, the Vivo 65 “…provides the ability for our patients to have better outcomes…” Currently about 60% of his ventilator patients are using Vivo 65 ventilators. He has numerous stories about how the Vivo 65 improves the quality of life for his ventilator patients.
Jorge and his staff reviewing ventilation data from a patient on a Vivo 65 using Breas PCSW.
Jorge attributes many of these quality of life improvements to the Vivo 65’s unique and patented eSync trigger and leak independent technology that reduces patient ventilator asynchrony. Contrasted to other ventilators that use a flow or pressure changes to sense patient inspiratory effort, eSync technology uses airway gas flow velocity acceleration generated by a patient’s inspiratory effort to sense and trigger breaths. With the use of flow velocity acceleration, eSync provides leak independence as the slow and constant flow typical of patient interface leaks is not sensed as airway gas accelerations associated with patient inspiratory effort.
The patient comfort provided by eSync’s leak independence is a key factor for many of his patients. For example, patients receiving non-invasive ventilation on other ventilators with full face masks whose masks were constantly tightened to stop leaks. Some of the patients have muscular twitches that make it difficult to keep the mask on their face. Jorge says, “The head gear kind of gets impregnated in their skull and they are not able to talk. They can’t do anything.” With a change to a Vivo 65 ventilator, the leaks no longer affect the treatment. Some patients no longer need a full-face mask. They can be ventilated by using a nasal mask or even a nasal canula. They still maintain the CO2 levels that indicate they are being properly ventilated. As he says, “I believe that if I put a patient on a Vivo, you’ll definitely have a better chance to have a better quality of life and have the little things that people, like us, take for granted. When you’re on any other ventilator 24/7, you are unable to talk. You have to rely on a speaking valve to talk, having to overcome the resistance of this valve, and work so hard to be able to breathe through a valve that is restricting the air that you’re bringing in. It’s a significant game changer in my opinion, when you get to talk without the need of a speaking valve like the patients on Vivo 65 do.”
With increased use of the Vivo 65 ventilator in his practice, Jorge has seen a reduction in the number of masks that he is called out to replace to try to fix leaks. With other ventilators he sometimes replaces masks multiple times trying to find one that does not leak, an expensive proposition. The Vivo 65 ventilator has eliminated this problem due to its leak independence.
Jorge has other patients who were intubated with a cuffed tracheostomy tube. The cuff pressure had been increased repeatedly in an effort to stop the leaks to the point the patient could no longer talk. With the change to the Vivo 65, the cuff could be deflated and as a result, they could talk again. As he says, “they could talk and that’s better outcome in my book. I believe that losing the ability to talk, as a result of an overinflated cuff because you have to take care of a leak, otherwise the ventilator will not work; those are the things that drive me to believe that my patients have better outcomes” with the Vivo 65.
Jorge also attributes eSync trigger technology with another outcome improvement related to patients’ reduced work of breathing. He measures the improvement versus other ventilators by evaluation of minute ventilation as well as by what patients tell him. “They tell us, “When I’m on this machine, I feel like I’m not so tired anymore.” They have to work so hard to overcome the asynchrony from the machines that it’s really difficult to breathe sometimes and they have to work so hard to get the air… With the Vivo 65 breathing is much easier.” One unexpected result seen is patient weight gain. He theorizes that this is because they are not burning as many calories to breathe.
Another Vivo feature Jorge likes is the Pre-use Test that measures and calibrates the ventilation delivery from the resistance and compliance it measures in the circuit. With this test he knows that regardless of the length or type of circuit used, the Vivo will deliver the same ventilation. Many flow cycle ventilators do not have a circuit calibration test, so clinicians have to adjust the pressure to increase the volume without knowing how accurate it is many cases.
Jorge’s pursuit of continuous improvement to better the outcomes for his respiratory patients led him to the Vivo 65. He now uses his experience to influence doctors and other therapists who send him referrals, especially those with patients that have failed on other ventilators. He seeks out referrals who are open to new concepts and the pursuit of excellence like himself. “I believe that this ventilator is the way of … ventilating people in the future. There’s just no doubt in my mind and clinically I see it.”
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