Chair set-up: The primary set-up used by myself during the daytime is a mouthpiece connected to the ventilator supported by a flexisble metal tubing called a "gooseneck clamp". The pictures are one of an overall set-up of a mouthpiece on a wheelchair and one of what pieces of equipment are needed and how they are put together.
Bed set-up: The secondary set-up used by myself during the daytime is a lipseal which can be used in bed. The pictures are one of an overall set-up of lipseal being used in bed and one of what pieces of equipment are needed and how they are put together.
Custom nasal mask: Overnight I use a custom made nosepiece. A mold of my face was made from which the nosepiece was cast. Over the counter nosepieces are on the market which do work but it's hard to get a good seal and they tend to cause skin breakdown.
Prefabricated nasal masks: Here is picture of a pre- fabricated nosepiece I use. While a custom nasal mask seals better it isn't practicle everywhere. They tend to be somewhat fragile. I use a prefabricated nosepiece as a back-up to my mouthpiece while I'm out of the house and traveling in my van with one person. I only use my custom nose piece overnight and when I'm lying down for a long period of time.
The Chest Cuirass: A chest cuirass (or chest shell) is a device that fits over your chest area much like a breast plate only there is about a 4" space between the shell and your chest. A rubber or foam seal is attached to the edges of the shell thus creating a fairly efficient seal. In the center of the shell, there isa port to which a hose is attached. The other end of this hose is attached to a negative pressure ventilator. This ventilator cycles air in and out of the cuirass. The negative pressure creates a vacuum by sucking air out of the space inside of the cuirass. This, in turn, causes the chest to raise and inspiration to occur. These machines can also create a positive pressure during the cycle which pumps air into the space inside of the cuirass thus helping to push air out of the lungs (somewhat like theHeimlich maneuver)
In ivasive ventilation secretions are removed by using a standard suctioning device. For a great deal of non-invasive ventilator users the greatest problem with getting up secretions is tha lack of an adaquete cough. Because of this reason even minor respiratory infections such as colds can easily lead to phemonia. I use a machine that enables me to bring up secretions without resorting to using invasive suctioning catheters.
The In-Exsufflator: (also known as the Cofflator) simulates a cough by using an inspratory cyle followed by an expratory cyle of air. A standard ambu bag mask connected to the machine through tubing is placed over ones mouth and a series of about six or seven cycles of air are administered. Or until congestion comes up. Being non-invasive the In-Exsufflator can be used frequenly without irritating ones airway. Also, because I have difficulty swallowing I tend to get small food particles lodged in my throught. I use this machine to bring up these particles. For me it is an priceless piece of equipment I could not do without.
The Oxcimeter: Used in conjuntion with the In-Exsufflator measures the oxygen percentage in the blood by using.a small probe which is placed over the tip of ones finger. Accordinng to what reading you get you can determine if any mucus plugs still need to be brought up and weather or nought you might be developing phemonia.
All of the items listed above should be available from most respiratory equipment companies. Here is the web address of the company I use.
Millennium Health Care, Inc
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