Under the direction of Sandra Henry, Autumn Lake Healthcare at Bridgepark changed over to Vivo 50 ventilators with the goal to deliver elite-level care for their ventilatory care patients. This story looks back over the last 2 years to explore how that change helped them reach their elite-level care goal.
Autumn Lake Healthcare at Bridgepark
Autumn Lake Healthcare at Bridgepark in Maryland is a Short-Term rehab and Long-Term Living Facility whose mission is to inspire our residents to live life to its fullest by providing them with elite-level care in a warm, energetic, and vibrant atmosphere.
Sandra Henry, BSRT, RRT-PDE
Sandra Henry has a long and successful career in the Respiratory Therapy profession. Her career started off in the critical care hospital setting, then branched out while there to become a clinical instructor for respiratory therapy students at a local college. She then moved into home care where she advanced into management and learned all of the different components of the healthcare process. From home care she went into medical device sales before finding her current position as Respiratory Therapy Director at Autumn Lake Healthcare at Bridgepark. Sandra helped build the ventilatory care program at Autumn Lake Healthcare at Bridgepark where she directs 24/7/365 respiratory care with a staff of 12 Respiratory Therapists. Her team is responsible for ventilatory dependent and transitional ventilation patients on a 28-bed ventilator unit that typically has 22 ventilators in service. Autumn Lake has used Breas Vivo 50 Life Support ventilators to treat their patients since March of 2019.
Vivo 50 Setup at Autumn Lake at Bridgepark
To meet but not exceed patient oxygen needs, the Vivo 50s are equipped with FiO2 modules to ensure precise oxygen delivery. For patient safety, ventilator alarms are annotated by a nurse call system. The nurse call system provides the alarm room location as well as how long the alarm has been active. To facilitate easy bedside care, the Vivos are mounted on the headwall behind the patient’s bed and transferred to a roll stand when the patient is moved from their bed.
Interview with Sandra Henry
Autumn Lake Healthcare at Bridgepark’s website states, “At Autumn Lake, our mission is to inspire our residents to live life to its fullest, providing them with elite level care in a warm, energetic environment atmosphere.” And specifically, about Ventilatory Care, “Works with resident and family to recover maximum function with a goal to wean every resident as safely and quickly as possible.” How has the partnership with Breas helped make those goals a reality?
Well, the one thing that I really do like is that there are multiple profiles on the machine itself, when we have patients that we are actively weaning it helps to have the capability and ease of switching profiles. Before Vivo, we would have to go in and manually switch every single mode, every single setting each time just to wean from one mode to the next, very frustrating as an RT, because time is of the essence with a lot of things. So, with the Vivo 50’s multiple profiles availability, we can easily switch a profile, saving time verses trying to manipulate the vent. This is an easier, more proficient way to wean our patients therefore, we have more time to assess them.
What is your weaning protocol? How does the Vivo 50 help with that?
So right now, weaning protocol is when they are on full ventilatory support, what we want to do is take them off of total control, which would be an AC mode, to a more spontaneous mode like pressure support. We’re taking away that set tidal volume, that set respiratory rate, and just giving them a little bit of PEEP and a little bit of pressure support to help them overcome the resistance of what can feel like essentially breathing through a straw. But they have to initiate every breath and however much tidal volume they can generate is what they receive.
What we would do first is if their ventilator settings are high, we’ll first try to adjust those settings down to being within a normal range and then make sure they can tolerate it. Once we get to that point, then we will try switching them to a pressure support mode, let them initiate and do all of the work of breathing and see how they do. This process would continue with daily weaning trials. Whether they can tolerate it for a short period of time or all day just depends on the individual patient. What we work towards is to get them to the point where they can tolerate being on pressure support all day and then in the evening time we rest them on full support, with the goal of building their endurance during the day and resting them at night. Repeating this process until the patient shows they are ready for the next step of weaning.
Once we establish that the patient can tolerate the first steps of weaning our next step is to try and see if they can tolerate being on pressure support around the clock. This will let us know if they can manage their oxygenation and their ventilation while they’re awake and while they’re asleep. If they can tolerate that, then our next step would be to try and take them off of the vent during the day onto another device that just provides humidification and oxygen if needed and then resting them at night on the vent just on pressure support. Again, dependent upon how well they do, the time off the vent could be an hour or all day. This process would be repeated daily until we can get them off the vent for a full 24 hour period. Usually after 72 hours if they have not been back on the ventilator, that’s when we would discontinue the vent.
How do the Vivo’s Profiles help with weaning?
When you are weaning, some patients don’t tolerate it, especially at first. So, if your patient was in distress, it would take you a minute or two to have to go through and reset everything. Meanwhile, your patient is still in distress. But with the profiles, it’s basically two clicks and they’re already back on full support. So, it does reduce the amount of stress your patient endures because it’s a lot quicker of a change.
What are your experiences with COVID patients?
These patients are sick. You know, one thing that we have noticed, especially with COVID, is that the patients that are coming to us are a lot sicker than they once were. Not sick enough essentially to be in the hospital, but maybe not quite as—how we normally would have accepted a patient into this type of a setting. So, we are having patients that are more acute and complex than they used to be.
Choosing the Vivo 50
How did you first learn about the Breas Vivo technology?
Autumn Lake Healthcare at Bridgepark hired a pulmonary consultant who worked with Venture Respiratory that utilizes the Vivo and that’s when we were introduced to it. So because I had not worked with the Vivo before, I decided to do some research and educate myself before it was put into use.
What factored into your decision to feel comfortable with going with technology you never knew about? What really grabbed your attention, said, “Yeah, I want to use these vents?”
Just word of mouth. Talking to my ex-boss, because he had used them (Vivos) for years, in a facility and in home care. “All right, well, what are the pros and cons?” And he didn’t have any cons. So, I thought, “Okay, well then this should be a good thing.”
Also, the fact that they can use it in home care as well because it’s extremely user-friendly. In this type of setting, we have respiratory therapists who basically, bottom line, a vent is a vent, but having a vent that can be easily navigated and you don’t have to go through five different touch screens just to get to the one you need is very helpful and time effective. The fact that the Vivo is straightforward, the buttons tell you exactly where it will take you when pushed. The little “i” button is especially helpful for anyone who is not a respiratory therapist. Example being if something were alarming, if a nurse is in there she can easily hit that “i” button and the machine itself will tell her, “Hey, look, this is probably what the problem is.” So it makes a machine that can often be intimidating to some less scary.
Please share some patient care experiences you have had with the Vivo ventilator.
When we first started switching patients over, obviously for every patient—it’s an adjustment. Every vent is a little bit different. We were previously using the Trilogys. The Trilogy ventilators weren’t as sensitive as the Vivos. So when we first started transitioning patients over, we were noticing that they were—a lot of them, were hitting the high pressure alarms a lot. So the initial adjustment for some took a little bit longer, but that’s just because Vivo is a lot more sensitive, which we want a vent to be sensitive. So I would say—and it didn’t happen for all patients, but after the first 24 hours, everybody kind of had settled in and they all adjusted. I didn’t have any patients that could not tolerate it, so it was just getting over the initial change in sensitivity, but then that wasn’t a problem.
I did have one patient that, probably about a week or two later, she started developing some increased respiratory symptoms possibly of a newly developed lung infection, but the ability to switch her to a pressure-controlled mode that had the augmented tidal volume (TgV) was just amazing because I wanted to limit the amount of pressure so I could protect her lungs, but I also wanted to be able to ensure that she was being ventilated correctly. So the fact that the vent had that mode, it was an easy switchover. As soon as we made that change in mode, her breathing got easier, she calmed down, her peak pressures went down, and we were able to keep her in house without sending her out to the hospital while we did a full work-up.
So the ability to have several different types of modes that I can rotate through in order to find the right one definitely was helpful in keeping a patient like her with us instead of having to send her out to the hospital.
Introducing the Vivo 50
Tell us about the whole startup with the Breas Vivo Ventilators. You’re new. You’ve got your new staff. You’re bringing in new ventilators. How did that go?
Breas’ Clinical Services Director Michael Griggs had come down a couple times to provide in-services with respiratory and nursing staff. He provided tons of literature that we were able to keep out at the nurses’ stations and respiratory department, and then of course he gave additional instruction to myself multiple times so after he was gone, I could then help my staff with any issues that they might come across.
When we did the initial switch over, he actually had come down to help me. We would go patient to patient, room to room, and we would set the machine and then take them from the Trilogy and put them on the Vivo, see how they do. We started at one end and worked our way all the way down.
How has the support been since? You have had them in service now, this is the second anniversary, which is pretty amazing. How has Breas treated you?
Whenever I’ve had a problem or a question, Breas been right there to answer or help, so I don’t have any complaints with that.
What does your staff tell you about the Vivos?
I just hired a new RT for night shift and they and all others say it’s easy to learn and they learn it quickly, because it’s straightforward. There are no hidden things here or there. A button that says Mode, you push that, and you get the mode, button Setup, that’s what it is. There’s no hidden features that you’ve got to try to remember, “Wait, how did I get through to that?” So it’s very straightforward and they don’t have a problem picking up on it, it’s very easy.
When I hire staff, I don’t hire anybody without critical care experience, because we don’t have an onsite physician 24 hours a day, so I need the experienced RT that has a good critical care foundation, “I know what to do.” The overall respiratory stuff is going to be the same, what’s different is the equipment. Sometimes that can be intimidating, but the fact that we’re using the Vivo 50s and there’s not a lot to it, it does what it needs to do, and it doesn’t complicate things it makes care and the learning process a lot easier. Then I don’t have these RTs that are like, “Oh, I need more orientation. I need more orientation. I need more orientation.” It’s a fact of, “Let me mess around with it for a little bit. Let me see it in use. Okay, I’m good to go.”
The Vivo 50 Difference
Concerning weaning that you mentioned earlier. Do you think there’s any difference in — in addition to profiles, of the performance of the Vivo versus the previous ventilators that were in play first in terms of the ability to wean a patient. Are you seeing any improvements with success?
The Vivos alert us when there is any change at all, so then we can assess quicker. We’ve got two that have been successfully weaned off recently. We’re currently working on a third one right now. We just started the process of trying to take her off of the vent during the day just to see how she does. I find that we’re weaning more frequently now that we have the Vivos than we were before. Since we’ve switched to the Vivos we still do have our chronic, long term patients, but for the ones that we’re weaning, we’re actually able to wean them.
How does the sensitivity of the ventilator, the Vivo eSync triggering algorithm, help with weaning?
Basically, we want the vent to sense what the patient is doing and sometimes if a vent is not sensitive enough, if a patient tries to trigger a breath, it’s not going to register so the patient can become air hungry. So, if you have a vent that basically is in sync with the patient, it will sense what the patient wants, and it will either deliver it or it will back them up. As far as pressure support, since we’re not giving a set tidal volume, we’re not giving a set rate, we want to make sure that if a patient initiates that breath, they’re going to get that inspiratory pressure and PEEP. If it’s not in sync with them and they try to initiate a breath, they’re not going to get anything, so they’re going to be air hungry and they’re going to be gasping.
Sensitivity has to work with them, each patient tries to take a breath in differently. Some people are very active, and you can actively see them trying to take a breath. Other patients’ effort is very minimal. So, we need a vent that can do the range. That way if a patient immediately tries to start sucking in a big breath, that vent has to react. But then if we have a patient that just is barely sucking in, we still need that vent to react. It has to be able to work with the whole spectrum of patients, because different patients have different inspiratory efforts. If the machine is in sync with them, we know that it will compensate for each of the patient types.
It sounds like you’re very confident that if the patient has inspiratory effort, the Vivo ventilator is going to give them the breath they’re looking for and that they’re not going to be struggling and air hungry.
Have you seen any issues with asynchrony where the Vivo ventilators are delivering breaths that the patient doesn’t want?
No. I have not had that.
So in your experience, the Vivo ventilator is going to breathe with the patient.
Now, if someone were to ask you, “Sandra, we’re considering going with the Vivo ventilator in a post-acute care facility,” what would you tell them? What would you tell them about Breas and the Vivo technology?
I would say the biggest thing is you can use it in a setting like ours as well as home care. It’s very versatile. It’s very user friendly. It’s straightforward. It has a ton of capabilities that can give you a slew of information that if you really wanted it, you could get it. Having modules that connect directly to the vent and that can measure things such as SPO2, end tidal CO2, and FiO2 eliminates the need for excess equipment, because everything would be measured and monitored through one machine.
The fact that you have capabilities to monitor so many different things. You have the ability, if you wanted to, to mount it on the wall to take up less space in the patient room. The fact that it is straightforward. I mean, really there’s no reason why you wouldn’t want to use it.
Is there anything else you want to share with me before we wrap up, Sandra?
Having worked with so many ventilators in the past, the fact that this one is truly portable, if we wanted to, we could take a patient down to rehab if they were a patient that needed the ventilator 24/7, they’ll have the ability to do that, because it has a long battery life. We can monitor them and make any changes necessary. It’s easy to wean them. It’s a very user-friendly vent, which when you’ve got so many other things going on, that’s very helpful, because the last thing you need is to be wasting time trying to figure out, “What was I supposed to do with this? Where am I supposed to go?” It’s touch of a button, here, boom, it’s exactly what it says it does.
Well, thank you so much for spending time with us Sandra.