Adaptive Bi-Level
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Detection - Excessive leak is evidenced by a large leak flow
indicated under the estimated tidal volume (> 30 Lpm) or by
visually examining the mask interface about the patient's face.
Intervention - Ensure that an approved and suitably sized nasal
mask or facemask is being used (see manufacturer’s
instructions). Adjust the headgear and ensure that there is
equal tension among all of the straps. If necessary, apply
padding across the nasal bridge and chin.
Non-Triggered Breaths (Inspiratory Trigger Failure):
Detection - Failure to trigger the ventilator is detected by
patient dysynchrony with mechanical breaths. These are
apparent as spontaneous efforts, on the flow waveform, that do
not result in a rise in pressure on the pressure waveform.
Intervention - Make sure that the enclosed volume of the
facemask is not too large, or that the facemask is not poorly
applied (see section under excessive leak). If the pressure
trigger is greater than -0.5cmH2O decrease the pressure trigger
level, also ensure that flow triggering is set higher than 2 L/M,
and try decreasing this value.
Excessive Triggering (auto cycling):
Detection - Auto cycling is detected by the observation of a
rapid auto cycling pattern independent of the patient's
breathing pattern.
Intervention – Increase the flow trigger setting first. Then after
observing the patient and confirming the persistence of auto
cycling, try increasing the pressure trigger setting. Confirm that
the facemask interface has a tight seal. If persistent, consider
recalibrating the unit.
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