Bilievel titrations

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Bilievel titrations

Postby rangerray300 » Wed Nov 20, 2013 2:38 pm

I've been working in sleep labs for just over a year now. Odd as this may seem, I haven't done a Bilevel titration yet. Not until I started working full time in a new lab where I'm working by myself. I've had two patient's that I have ran and neither one had went well.. first one the pt really didn't sleep all night, so not much I could do there. Second pt sleep well in 20min stretch's. Maybe I just got two pt that can't handle the pressures but I keep feeling like I should have been able to do something. I just feel bad that I couldn't help these patient's!
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Postby SCNVsleep » Sat Nov 23, 2013 2:16 am

If this isn't posted in your PnP manual it should be. It's not perfect, but it is the first long step toward standardizing how titrations are approached.

http://www.aasmnet.org/Resources/clinicalguidelines/040210.pdf
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Postby lil_miss_sleeptech » Wed Dec 04, 2013 7:32 am

I agree with SCNV that your P&P manual should have your protocols.

That being said (and you probably already know this from your CPAP titrations, but it's even more important with Bilevel), I think PATIENCE is the key to a good Bilevel titration. I think we all have a nasty (or superhero-complex-based) habit at times of wanting to fix the patient RIGHT NOW....and because of that, sometimes end up not looking ideal.

I think having an end goal is important, too; is the person retaining CO2, and you're trying to remedy that? Are they having flow limitation or pesky, long hypopneas in REM? Tweaking just the IPAP was foreign to me when I first started, and now I know it's the key to successful Bilevel.

Also...it just takes time! The more Bilevel titrations you do, the more comfortable you'll get with them. If you feel comfortable (I truly hope you do!), ask your lead tech/scoring tech/manager to provide as much feedback on your Bilevel titrations as possible, so you can learn from each one.

One more thing: just the fact that you're worried about wanting to do better means you absolutely WILL do better! It shows you care about your patients and you want to learn as much as possible. Keep at it. Remember:

Follow your lab's P&P
Ask for feedback
Be patient
You've. Got. This.

:D
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