Patient has pulmonary fibrosis, on 6-8 liters of oxygen at home. Doctor wants sats 86-91 but they’re staying in low 80s. Patient only has use of her upper lobes. Her carbon dioxide levels are extremely high (119 when we brought her into the hospital a week ago.. we’re still here on high flow oxygen) and we need to get them down to keep her out of the ICU. She’s been given 2 choices - Trilogy Ventilator or a trach. She’s tried trilogy before and she complains that it hurts really bad. Has it done this to anyone before, or could it be because she only has use of her upper lobes? Is there anything we can do to make it more comfortable for her?