List of BIPAP machines with Backup rate?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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palerider
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Re: List of BIPAP machines with Backup rate?

Post by palerider » Wed Oct 29, 2014 1:55 pm

ShaneRRT wrote:palerider:

I'm not sure where your information is coming from, but the 36018 is not an "old VPAP". That is indeed the part # for the current VPAP ST (36008) + Hi5 humidifier. We almost always recommend using a humidifier with a CPAP or BPAP. This is a current model, I put patients on them all the time.
from resmed's product sheet on the vpap series:

http://www.resmed.com/us/dam/documents/ ... er_eng.pdf

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ShaneRRT
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Re: List of BIPAP machines with Backup rate?

Post by ShaneRRT » Wed Oct 29, 2014 2:01 pm

from resmed's product sheet on the vpap series:

http://www.resmed.com/us/dam/documents/ ... er_eng.pdf
That sheet is 3 years old. I know that's not your fault. They obviously need to update their documents. On a side note...I deal with these machines on a daily basis and I find that Respironics algorithms are superior to ResMed, but I utilize both manufacturers with my patients.

Cheers!
Shane, RRT

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palerider
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Re: List of BIPAP machines with Backup rate?

Post by palerider » Wed Oct 29, 2014 3:35 pm

ShaneRRT wrote:
from resmed's product sheet on the vpap series:

http://www.resmed.com/us/dam/documents/ ... er_eng.pdf
That sheet is 3 years old. I know that's not your fault. They obviously need to update their documents. On a side note...I deal with these machines on a daily basis and I find that Respironics algorithms are superior to ResMed, but I utilize both manufacturers with my patients.

Cheers!
Shane, RRT
I''m so happy for you.

so, what you're telling me, is that, in your learned and experienced opinion, resmed replaced a higher numbered machine with a lower numbered machine for whatever reason? or just changed the numbers?

btw, the page that I linked to is linked to from the page you linked. resmed can't make up it's mind.

I suppose it coulda happened that way. *shrug*

ok, so, anyway, whatever the number of the vpap st is, can you answer the question to the satisfaction of the OP as to what the functional differences in the ST and the adapt are, and what the indications are for one over the other?

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cnaumann
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Re: List of BIPAP machines with Backup rate?

Post by cnaumann » Wed Oct 29, 2014 9:09 pm

Here is my theory. It is full of speculation. Some of this is likely to be outright incorrect, but I bet there is at least some truth in it.

It is obvious that there is a great deal of overlap in the conditions that can treated with ST (set time) and ASV (automatic servo ventilation) machines. I cannot say why one is prescribed over the other. Like drugs, it may simply be the doctor’s comfort level and familiarity with the different machines. Based on pricing data that I can find (which is incomplete), there is not a huge different in price between the ResMed ASV, ResMed ST, and PR ASV. The only possible outlier is the PR ST machine which seems to be quite a bit more expensive.

It is interesting to me that PR lists their ST machine and their APV machine in completely different categories.

So here is my theory: PR developed a line of low-cost non-invasive respirators for treating a variety of breathing disorders including COPD and other disorders that requires monitoring the volume of air that a patient consumes and encourages them to take in at least a minimum quantity of air. This would be their assured volume (AVAP) line and they are primarily marketed as non-invasive respirators. They also realized that the same hardware platform could be used to treat CSA, and came out with their ST line that is pretty much the same hardware but different software. ResMed may have followed suit and come out with a similar line but at a lower cost point. PR then developed their ASV on a lower-cost hardware platform with more advanced software and marketed it exclusively toward the sleep medicine market, as the ASV line would unsuitable for treating conditions like COPD or OHS (obesity hypoventilation syndrome) where tracking a patient’s natural breathing pattern would be result in insufficient ventilation. That is my theory anyway.

I wish I could try several of the machines before committing to one. I am not 100% sure which machine they used in the titration study. I was not overly happy with the breathing algorithm, as I said before, I felt that it was fighting me most of the night.

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palerider
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Re: List of BIPAP machines with Backup rate?

Post by palerider » Wed Oct 29, 2014 9:27 pm

cnaumann wrote:ST (set time) and ASV (automatic servo ventilation)
that's Spontaneous/Timed and Adaptive Servo Ventilation.
cnaumann wrote: It is interesting to me that PR lists their ST machine and their APV machine in completely different categories.
well, if one were to go by resmed's titration protocol guide, the ST is indicated for:
• Neuromuscular/restrictive disorders
• COPD
• Obesity hypoventilation

and the adapt (asv, not APV) is indicated for:
• Periodic breathing, both normocapnic and hypocapnic
• Other forms of central and concomitant obstructive events (mixed sleep apnea)
• Complex sleep apnea (CompSA)

so, two rather different target audiences.

the ST machines don't have the programming to respond, breath by breath, with varying levels of pressure to act as a regular cpap when you're breathing by yourself, but then increase, or decrease, the level of ipap on a per breath, as needed level to make up for the waxing and waining that is characteristic of cheyne stokes respiration, for instance.

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Re: List of BIPAP machines with Backup rate?

Post by cnaumann » Wed Oct 29, 2014 10:31 pm

I appreciate your corrections, I am not trying to pretend to be any kind of expert on this, I am just trying to understand.

From what I can tell, ResMed's ST machine is also an assured volume machine so it would be suitable for treating COPD/OHV as well as other conditions where maintaining tidal volume is required.

It appears that PR markets an assured volume machine that contains the S/T triggers but also markets a simpler machine that contains the S/T triggers without the assured volume features.

The assured volume machines seems to increase differential pressure if tidal volume is low and will initiate a timed trigger if respiration is absent. As such, they may help to normalize periodic breathing but that does not appear to be their main function. The ASV machines appear to attempt to normalize periodic breathing but not attempt to maintain tidal volume. So I think those are your two very different animals.

What I still can't figure out is under what conditions the more expensive PR ST machine (without AVAPS) would be more appropriate than the PR ASV machine. It does go to higher pressures (30cm vs. 25cm) and it _may_ have a better instrumentation for tidal volume but all-in-all it appears to be much less capable than the ASV machine. I wonder if there are situations where the full AVAPS is not needed and the ASV would be detrimental, and the machine offers a slightly less expensive alternative to the full PR AVAPS machine.

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Re: List of BIPAP machines with Backup rate?

Post by palerider » Thu Oct 30, 2014 9:55 am

cnaumann wrote:I appreciate your corrections, I am not trying to pretend to be any kind of expert on this, I am just trying to understand.

From what I can tell, ResMed's ST machine is also an assured volume machine so it would be suitable for treating COPD/OHV as well as other conditions where maintaining tidal volume is required.

It appears that PR markets an assured volume machine that contains the S/T triggers but also markets a simpler machine that contains the S/T triggers without the assured volume features.
you're confusing the ST from resmed with the ST-A w/ivaps, which is the intelligent volume assured pressure support.

the ST does not have ivaps and does not vary the volume/pressure breath by breath.

same thing with the S/T and the AVAPS machine from PRS1
cnaumann wrote:
The assured volume machines seems to increase differential pressure if tidal volume is low and will initiate a timed trigger if respiration is absent. As such, they may help to normalize periodic breathing but that does not appear to be their main function. The ASV machines appear to attempt to normalize periodic breathing but not attempt to maintain tidal volume. So I think those are your two very different animals.
yes.

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ShaneRRT
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Re: List of BIPAP machines with Backup rate?

Post by ShaneRRT » Thu Oct 30, 2014 11:48 am

palerider:

You're quite the sarcastic a**hole which is pretty typical of internet tough-guys/low self-esteem twats. With people like you on here, it's no wonder that there aren't many clinicians posting in these forums. I'm sure you're the kind of guy that thinks he knows better than any professional he deals with. I've heard it before from guys like you..."that mechanic didn't know what he was doing", "that Doctor's an idiot, where did he get his license", "this tranny hooker doesn't know how to suck a dick, let me show him how it's done."

I'm done with you.

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Re: List of BIPAP machines with Backup rate?

Post by cnaumann » Thu Oct 30, 2014 11:50 am

palerider wrote:

well, if one were to go by resmed's titration protocol guide, the ST is indicated for:
• Neuromuscular/restrictive disorders
• COPD
• Obesity hypoventilation

and the adapt (asv, not APV) is indicated for:
• Periodic breathing, both normocapnic and hypocapnic
• Other forms of central and concomitant obstructive events (mixed sleep apnea)
• Complex sleep apnea (CompSA)
palerider then wrote:

you're confusing the ST from resmed with the ST-A w/ivaps, which is the intelligent volume assured pressure support.

the ST does not have ivaps and does not vary the volume/pressure breath by breath.
Obviously, it is the iVAPs feature that would be prescribed for the COPD and Obesity hypoventilation, not the S/T feature only. So I am not the only one 'confused.'

I have talked my doctor, my DME and I am in the process of talking to my insurance company. There are in fact some ST machines that are slighlty less expensive than the ASV machines. For treating CSA, they want you to fail on an ST machine before they will cover the additional cost of the ASV machine. Seems dumb to me, there is not a whole lot of cost difference in the machines and the machine costs are dwarfed by the sleep labs costs.
Last edited by cnaumann on Thu Oct 30, 2014 1:34 pm, edited 1 time in total.

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Re: List of BIPAP machines with Backup rate?

Post by Guest » Thu Oct 30, 2014 12:35 pm

ShaneRRT wrote:I'm done with you.
After only 3 posts - a new record. I do agree with your description of him tho, prob many others here do too. Unfortunately, no one has done anything about him but I am sure one day someone will grow a pair and fix this problem.

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Re: List of BIPAP machines with Backup rate?

Post by cnaumann » Thu Oct 30, 2014 12:47 pm

Shane, I appriciated your comments. I found them helpful. Thank you.

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Re: List of BIPAP machines with Backup rate?

Post by palerider » Thu Oct 30, 2014 12:55 pm

[quote="cnaumann"
Obviously, it is the iVAPs feature that is would be prescribed for the COPD and Obesity hypoventilation, not the S/T feature only. So I am not the only one 'confused.'
[/quote]

not according to the titration guide, which I suggest you get a copy of it and read through it yourself, instead of my quoting bits:
http://www.resmed.com/assets/documents/ ... lo_eng.pdf

jds has posted a link to the prs1 titration guide, though I haven't read it, it might help answer some questions you have about the prs1 line and what machine is suggested for what condition.

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Re: List of BIPAP machines with Backup rate?

Post by palerider » Thu Oct 30, 2014 12:57 pm

ShaneRRT wrote:palerider:

You're quite the sarcastic a**hole which is pretty typical of internet tough-guys/low self-esteem twats. With people like you on here, it's no wonder that there aren't many clinicians posting in these forums. I'm sure you're the kind of guy that thinks he knows better than any professional he deals with. I've heard it before from guys like you..."that mechanic didn't know what he was doing", "that Doctor's an idiot, where did he get his license", "this tranny hooker doesn't know how to suck a dick, let me show him how it's done."

I'm done with you.
jeez, I thought it was the doctors with the god complex.

I notice you didn't actually provide any useful info as requested, like, what conditions call for a ST machine vs what conditions call for a ASV, or a ivaps/avaps machine.... which, really, was what the OP was asking.

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Re: List of BIPAP machines with Backup rate?

Post by palerider » Thu Oct 30, 2014 12:59 pm

Guest wrote:
ShaneRRT wrote:I'm done with you.
After only 3 posts - a new record. I do agree with your description of him tho, prob many others here do too. Unfortunately, no one has done anything about him but I am sure one day someone will grow a pair and fix this problem.
oh, I figure I'm safe as long as they let assholes like you post crap anonymously...

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Last edited by palerider on Thu Oct 30, 2014 1:30 pm, edited 1 time in total.
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Re: List of BIPAP machines with Backup rate?

Post by Sclark08 » Thu Oct 30, 2014 1:06 pm

ShaneRRT
You are so correct about some of the people who post on here. For a while I thought it was just me who thought that but Im finding out different. I found a new sight with some caring knowledgable people.