vpap-s TRIGGER/CYCLE

Hi, I was wondering if someone could help with the Trigger/Cycle adjustments on my s9,factory default is med. if i step down to low or very low will that be more likely to cause auto-PEEP or would that be from stepping up to hi or very high ? i dropped Ti max from 2.0 to 1.0 seemed to breathe better and graphs smoothed some but only got 50 min. before power went out last night will try again to see a full night any help with T/C is MUCH APPRECIATED THANK YOU

Nite Ranger wrote:Hi, I was wondering if someone could help with the Trigger/Cycle adjustments on my s9,factory default is med. if i step down to low or very low will that be more likely to cause auto-PEEP or would that be from stepping up to hi or very high ? i dropped Ti max from 2.0 to 1.0 seemed to breathe better and graphs smoothed some but only got 50 min. before power went out last night will try again to see a full night any help with T/C is MUCH APPRECIATED THANK YOU

I'll take a swing at this since nobody with more knowledge has done so, so far.'

autopeep is what happens when you don't finish exhaling before starting another inhale. not quite sure how a vpap s would cause autopeep, since it doesn't initiate breaths on it's own.

however, as to trigger and cycle, since you want an extended exhale, the suggestions on the resmed titration guide for obstructive lung diseases may be somewhat applicable.

Patients with obstructive lung disease have chronic airflow limitation. These patients have particular difficulty exhaling air, which leads to air trapping and hyperinflation. These patients require a longer exhalation, which often leads to asynchrony with standard bilevel settings.
The recommended settings use a faster rise time to ensure that the lungs are filled quickly, and a high cycle sensitivity to provide an earlier cycle to exhalation. The rapid inhalation and prolonged exhalation will help to prevent auto-PEEP and preserve synchrony.

the settings are, ipap 13, epap 5, TiMax 1, TiMin .3, rise time 150, trigger medium, cycle high, ps 8

In case a visual would help for OP or others. Trigger: sensitivity in switching to IPAP pressure. Cycle: sensitivity in switching to EPAP pressure.

THANK YOU Pale Rider and Kaiasgram for responding,I admit im CONFUSED but you say vpap wont cause auto peep yet the resmed vpap guide at bottom of your reply talks to PREVENT AUTO PEEP, and the vpap s guide i found states "More sensitivetrigger & cycle settings [high/very high] are for patients with high resistance,including obstructive lung mechanics,intrinsic PEEP [auto peep] make it difficult to trigger. yet less sensitive are forpatients prone to auto-triggering,patients with restrictivemechanics & longer exp.pauses ??? so high & very high would be more useful for someone with copd ? wich is obstructive rather than restrictive ?? thank you both again i guess i just dont understand thanx

Nite Ranger wrote:THANK YOU Pale Rider and Kaiasgram for responding,I admit im CONFUSED but you say vpap wont cause auto peep yet the resmed vpap guide at bottom of your reply talks to PREVENT AUTO PEEP, and the vpap s guide i found states "More sensitivetrigger & cycle settings [high/very high] are for patients with high resistance,including obstructive lung mechanics,intrinsic PEEP [auto peep] make it difficult to trigger. yet less sensitive are forpatients prone to auto-triggering,patients with restrictivemechanics & longer exp.pauses ??? so high & very high would be more useful for someone with copd ? wich is obstructive rather than restrictive ?? thank you both again i guess i just dont understand thanx

please note, I said I wasn't claiming any expertise on the subject, and didn't see how a machine that didn't drive your respiration with a backup rate would cause autopeep I didn't say it wouldn't, only that I didn't know.

I don't see anything in my vpap s guide about autopeep.

see page 22:http://www.resmed.com/assets/documents/ ... lo_eng.pdf for what I was referring to.

Pale rider thanx again i was NOT complaining, im very thankful for any help, as to the titration guide on pg 21 ? under Ti control it speaks of controlling intrinsic PEEP which is auto peep according to the definitions ive found, again THANK YOU and admittedly im confused and not xpap knowledgeable as you and so many other helpful members are again thanx

Nite Ranger wrote:Pale rider thanx again i was NOT complaining, im very thankful for any help, as to the titration guide on pg 21 ? under Ti control it speaks of controlling intrinsic PEEP which is auto peep according to the definitions ive found, again THANK YOU and admittedly im confused and not xpap knowledgeable as you and so many other helpful members are again thanx

I just want to be clear when I'm not at least pretty sure, becuase I don't want to mislead someone with incorrect information. I'm hoping someone like sludge will weigh in and we'll both learn something

as to the Ti control, you'd already done part of that, iirc, by shortening the Ti times.

Thanks im trying to understand this and get more consistant and comfortable nights,ive had some real good ones and some bad,overall MUCH BETTER than without pap