To start ventilating a patient, the correct settings should be entered for the patient; this is the prescription.

To set up a prescription and start ventilatory support using the Trilogy Evo ventilator, proceed with the following steps:

1. Turn on the machine, and permanently unlock the unit.
2. Return to the homepage of the device, and select ‘New Patient’. This will remove any previous prescriptions from the machine.
3. Select one option from the menu ‘prescription name’. If it is necessary to change the prescription from daytime to night-time, for example, you will be able to create multiple prescriptions.
4. To change the prescription, select the ‘Settings’ icon, ensure the Circuit is set to ‘Passive’ and Select the mode ‘S/T’.
5. Adjust the IPAP, EPAP and Respiratory Rate according to the prescription. Once these have been set, click to ‘Accept’ your changes.
6. Select the alarm menu to adjust the alarm trigger, and click ‘accept’.
7. The machine is now ready to start ventilation. Click ‘Start ventilation’ when the circuit is set up.

When an alarm is triggered, this means the patient has become disconnected from the circuit. Proceed as follows:

1. Select the ‘silence alarm’ button on the front of the device to silence the alarm.
2. Locate the point of disconnection; usually the patient interface (mask) has been displaced, but it might also be a leak in the tubing.
3. Reconnect the circuit.
4. Click to reset the alarm.

To change the prescription while the patient is using the ventilator:

1. Click on the settings icon.
2. Adjust the IPAP, EPAP and Respiratory Rate according to the prescription. Once these have been set, click to ‘Accept’ your changes. This will update the prescription immediately.
3. To change the alarm settings, select the alarm menu to adjust the alarm trigger, and click ‘accept’.
4. Return to the home screen to view the ventilation screen.

Ventilator terminology differs between manufacturers. Here is a list of the terminology that we have seen in this video:

• Non-Invasive Ventilation (NIV), also known as Bi-level Positive Airway Pressure ventilation (BiPAP) consists of two levels of pressure: inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP)
• Inspiratory Positive Airway Pressure (IPAP) is the pressure that is provided to a patient during inspiration
• Expiratory Positive Airway Pressure (EPAP) is the pressure that is provided to a patient during expiration. This is sometimes also referred to as PEEP (Positive End Expiratory Pressure)
• Continuous Positive Airway Pressure (CPAP) supplies constant fixed positive pressure throughout inspiration and expiration
• Spontaneous/ Timed mode (S/T mode) is the mode of triggering a breath; the patient might spontaneously trigger a breath and the machine will deliver an IPAP, or if the patient does not trigger a breath spontaneously the ventilator will ensure a “backup” rate is set to ensure that patients still receive a minimum number of breaths per minute
• Breath rate is the minimum number of breaths per minute if that patient does not trigger their own breath
• Circuit disconnect alarm can be set to trigger when the patient has become disconnected from the circuit; by a poor fitting mask, or other leak in the patient circuit
• Spontaneous breath (%) is the percentage of the patient’s breath that is triggered spontaneously
• Respiratory rate (RR) is the current rate of respiration as measured by the ventilator
• Leak (litres/minute) is the amount of air that leaks from the circuit, often due to a poorly fitting mask. A high leak (>60litres/minute) means the patient is not getting enough pressure support from their ventilator. Check the circuit for the leak, and resolve the issue