Can someone explain the functionality ASV settings?

[Dave5059]

I was wondering if any can explain on a 'basic easy to understand' level about if EPAP helps with Centrals or Obstructive? If PSMin helps with Centrals or Obstructive? When would be a good time to change the BPM 'Auto' setting. For instance how would the person need to breathe in order to change the Auto setting for bpm?

[chunkyfrog]

Bump, or hop. Keep smiling!

[grayghost4]

How much to Haunt a house ..... depends on how many rooms.

[JDS74]

I was wondering if any can explain on a 'basic easy to understand' level about if EPAP helps with Centrals or Obstructive? If PSMin helps with Centrals or Obstructive? When would be a good time to change the BPM 'Auto' setting. For instance how would the person need to breathe in order to change the Auto setting for bpm?

Let's try to explain what happens in a Respironics 960 ASV machine. Details will be different for a ResMed equivalent.

Min EPAP is the continuous lowest pressure the machine supplies. The pressure will never go below this value. In general this helps prevent Hypopnea events.
Max EPAP is the highest pressure the machine will go to in EPAP mode.
Min Pressure Support is the continuous lowest pressure above the current EPAP the machine supplies in IPAP mode. It helps prevent obstructive events.
Max Pressure Support is the highest IPAP pressure above the current EPAP value that the machine will supply in "normal" IPAP mode.
Max Pressure is the maximum pressure the machine is allowed to provide. Many are set up with this pressure set to 25 CmH2O, the actual machine upper limit.

Compared to a BiPap machine, EPAP will be Min EPAP and IPAP will be Min EPAP + Min Pressure Support.
IPAP will never get below Min EPAP + Min Pressure support and it will never get above Min EPAP + Max Pressure Support when not in ventilator mode.

As needs change, the values for EPAP will vary between Min EPAP and Max EPAP, and IPAP will vary between Min EPAP+Min Pressure Support and Max EPAP and Max Pressure Support. Respironics algorithm allows both the current EPAP and the Current IPAP to vary independently but never letting them get closer than Min Pressure Support.

Now here comes a central event (ventilator mode).
Then EPAP will revert to Min EPAP, the upper limit for IPAP switches to Max Pressure. All else remains the same. The 960 will try to titrate up to Max Pressure in order to keep the patient breathing and assist in restoring normal breathing effort. The longest my machine kept me in this mode was a little over two hours one night but I frequently see runs of 5 to 15 minutes. BTW, I don't wake up during the periods switching between 12 CmH2O and 25 CmH2O, my current settings.

[JDS74]

... When would be a good time to change the BPM 'Auto' setting. For instance how would the person need to breathe in order to change the Auto setting for bpm?

The time to consider changing from Auto mode to a fixed setting is if you breathing rate is really unstable and you can see by looking at the wave data that ventilator mode is triggering only because of this instability. That is, your breath rate goes from 10 BPM to 18 BPM erratically during the night but you are not having centrals. Generally, though, leaving the machine in Auto is better as it can cope more easily In this mode.

[Pugsy]

http://www.isetonline.org/yahoo_site_ad ... 190318.pdf


EPAP is used for obstructive events...either OAs or hyponeas that are obstructive in nature.
Remember hyponeas can also be central in nature.
So usually it is EPAP for OAs and IPAP for hyponeas that are central in nature because that's where PS comes in to help with centrals.

See the above link for in depth explanation.

[Sir NoddinOff]

When someone refuses to list their equipment after a certain period of time, I tend to lead with a lot of cautions; especially if ASV is involved. Here’s an intensive video on ASV/ventilator principles and some cautions… If it gets too heavy going for you, then look to the right of the Youtube screen and you’ll see several thumbnails of other ASV/ventilator video tutorials of varying degrees of difficulty. Read what Pugsy linked to first:

https://www.youtube.com/watch?v=6nERo9g5sBU

Note that at about minute 24 in the video he discusses cardiac dysfunction resulting from some ASV/ventilator settings and people with heart problems - ie. closely related to the warnings popping up in May 2015 concerning ResMed's Emergency Alerts to their international medical clients, specifically regarding LVEF equaling or below 45% (Google it). This is the only really clear presentation of the material I've seen online. Earlier he touches on ASV relating to COPD issues. It's good concise stuff.

I'm not a doctor, so consult your medical team for any concerns you have.

[StephenR]

When someone refuses to list their equipment after a certain period of time, I tend to lead with a lot of cautions; especially if ASV is involved. Here’s an intensive video on ASV/ventilator principles and some cautions… If it gets too heavy going for you, then look to the right of the Youtube screen and you’ll see several thumbnails of other ASV/ventilator video tutorials of varying degrees of difficulty. Read what Pugsy linked to first:

https://www.youtube.com/watch?v=6nERo9g5sBU

Note that at about minute 24 in the video he discusses cardiac dysfunction resulting from some ASV/ventilator settings and people with heart problems - ie. closely related to the warnings popping up in May 2015 concerning ResMed's Emergency Alerts to their international medical clients, specifically regarding LVEF equaling or below 45% (Google it). This is the only really clear presentation of the material I've seen online. Earlier he touches on ASV relating to COPD issues. It's good concise stuff.

I'm not a doctor, so consult your medical team for any concerns you have.

What a great video..

Thanks for sharing that....

Stephen

[bwexler]

That was a great video.
Why didn't you tell me to watch it sooner?

He didn't exactly talk about PAP machines. But he certainly did explain ASV very clearly as well as what the settings mean.

Thank yo.

[palerider]

That was a great video.
Why didn't you tell me to watch it sooner?

He didn't exactly talk about PAP machines. But he certainly did explain ASV very clearly as well as what the settings mean.

actually, there was nothing in there about asv... that was pretty much all tightly controlled therapeutic ventilators.

the fact that there were a couple settings that you can find on an asv doesn't mean he was talking about ASVs, he wasn't.

that was more applicable to a bipap S/T or vpap ST-A.