Tidal volume and Flow limitations

[Rubicon]

And BTW stop talking about gravity.

Gravity has nothing to do with it.

[Rubicon]

So not understanding what's happening here. PS is 3.4 cmH2O with EPAP range 9.2 - 16.0. It looks like baseline is running at 9.2 and peak pressure is at ~14.0 (max IPAP is 16.0) Then you got this glitch at where min PS would be (give or take)(coincidence?) but could also be what might be seen in the aforementioned improperly set Itime) (in this case, ~2.5 seconds).



At the least, pressure waveforms shouldn't have glitches, and seems to me exhalation is partially against increased pressure.

As an aside, if IPAPmax and EPAPmax are the same isn't is possible to end up creating a stone wall?

[Rubicon]

...could also be what might be seen in the aforementioned improperly set Itime) (in this case, ~2.5 seconds).

OTOH, could also just be Frequency Response, where the abrupt airway closure supposedly caused by palatal prolapse sends a pulse back into the system.

[Rubicon]

OTO, OH (IOWs, back to the original hand) that wouldn't explain this guy, where a pressure breath is sent in during obvious exhalation:



Gotta admit, that's a pretty good trick.

[AmSleepnBetta]

I prefer to go on trying to explore, trying to make sense of and trying to illuminate flow limitation with such light as I think I have found to share. Do that whether or not I, an openly bumbling novice ("humble brag", he hates says Morbius) may ignorantly and unintentionally delude myself and others. I often declare being a mere novice, one not sure of what he is talking about, taking apart and trying to put back together as I bump into guardrails like my correction attests above.

Note to any expectant readers: Sorry. This post is a nothing burger. But it is my intent to soon post an Excel spreadsheet model that can be copied for doing special breath by breath or (for FL) 2-second by 2-second analyses of Resmed data files such as the EDF Browser outputs as txt files (as pictured and summarized above). The Excel spreadsheet will prepare direct import material for OSCAR to display among its graphs. I hope to do that very soon .

But I have a noise problem to deal with here rather than receipt of informed, thoughtful criticism and helps. Those additions would help us all, we who populate these sites because of deficient sleep care or knowledge of one kind or another. There are those lazy smart alecks, "with-its" and gunslingers, who pour out code and bile rather than contribute or start their own competing topical thread. They intimidate or repel accomplished DIY-people who could contribute far more than I to this thread on flow limitation.

Let me be clear as possible for me. As in my just previous post, I exactly, totally and wrongly interpreted the actual expirations as exactly equal leaks before seeing it necessary to reverse that blunder. My blunder. Nothing changes that. However, I, a novice and other-forum experts, including geer1 with other proven (non-professional) experts , have seen prolonged instances of Resmed devices being totally confused about zero axis location and other flow metrics--confusion, being the only possible explanation--confusion caused by pathologically irregular breathing flow rates, bizarre irregularities time and time again for long periods. I misapplied that awareness and stepped into the pitfalls I mentioned above. To my failing eye, all below the axis either had to be expiration or un-graphed leak. Correctly, one or the other entirely accounted for the bristle plot of volumes, for those leak or expiration areas enclosed under the axis and for the nil -.21 L residual cumulative total difference--either way.

I will respond to Rubicon's yammering and littering this time. But, unless he presents a worthy post (decoded, constructive, informative), I will not bother with his sniping further. I note he may have taken a step in that direction in one post I have not read but noticed just before starting this post. It looked like he was addressing my VAuto time and pressure settings. I clicked the comma hoping to respond to his work, to find it helpful. I'd be happy for a turnaround with him and Morbius, but won't be intimidated by flecks of covering legitimacy in BS flooded zones nor by veiled threats.

It's the same for Morbius as for Rubicon. Many of Morbius' posts have begged and awaited my response. I intend to do a couple or three selectively and let the rest be judged by readers' inductive reasoning. One most egregious instance will suffice by itself if Morbius does not find, acknowledge and correct it by PM soon. That kind of turns on where he stands. Summary/review: https://philosophynow.org/issues/53/On_ ... _Frankfurt Full treatment by professor-author: http://www2.csudh.edu/ccauthen/576f12/f ... llshit.pdf . The latter full treatment, read years ago, had this that caught my eye on its first page. It speaks to all my posting aims and is a segue: ". . . it should be possible to say something helpful, even though it is not likely to be decisive." SHOULD BE POSSIBLE, yes.



Once more into the fetid zone. Though it's unlikely to be decisive it addresses a couple glaring specifics:

The Cran Method would given you the solution:

Here I go one more time, kicking myself for wasting time feeding another troll by stooping to its level and trivialities. Apparently you are Morbius "successor" he posted might come: he/she would possibly and ostensibly come to teach, but unsurprisingly, has actually come to keep flooding the zone, maintain ad hominem attacks, boast, blunder, fail to read (or be unable to read, if not dishonest too). Anyway you carry on his work. You can't handle crayons, read, comprehend nor teach, let alone land a blow.

Your coloring of your illustrative flow rate curve contrasts one normal breath cycle with the inspiration half and fractional spike of an expiration, not even one PP breath cycle. It suggests that only the inspiration and the starting spike of the PP expiration curve counted, not even the rest of that just that one illustrative E-wave lying below the axis. Your own first coloring example gave no indication any of the dozen or so whole PP-affected expirations were expirations. You did, in my Excel FR curve, scatter some E-wave fill ins, albeit they are wrongly colored, given that inspiration oxygenates blood (helps make it red, get it?) and blue colors are cyanotic (blue) showing lack of oxygenation. Short "crans" ought to be kept away from small children who stuff 'em up their nose and--less harmfully?--swallow them.
"

Your waveform had no loss of volume:

Am pleased you at least seemed, there, to understand the "pitchur" and bristle graph point, those points for Morbius "inquiring minds", that inspiratory volumes balanced with expiratory volumes: not necessarily one-to-one, but in combinations among mixed successive singles, pairs or triples, such that the overall sum of volumes of the 20 breaths, inspiratory and expiratory, had a nil residual difference of about -210 ml (half an inspiration).

And when we're talking about missing 210 ml. relative to a total of 6600 ml. that has a +/- of 20%, that's absolutely insignificant.

Rubicon from the corner for the win...

Nothing but net!

Get back on the bus and go home!

At least you had the brains to understand the insignificance . Not bad for a toddler to get the "-21".

And BTW stop talking about gravity.

Gravity has nothing to do with it.

Wrong as can be, again and often. You are a fish who does not know there is water. Gravity has everything to do with many PAP treatment issues. Not just in supine sleep. Airway flabbiness. Big bosoms and belly and other fat of the obese. Headward fluid and mucus movement with wedge pillows and hospital beds to fight it. Then there is the little tiny matter of the matter causing atmospheric pressure because it arises from the matter of compressed gases (mass) and gravitational effect on them: weight = mass x g. Go sit on Mt. Everest unacclimatized and without O2, and see how your diaphragm and intercostals treat you, how elastic recoil of your muscles does for you. Likewise, better avoid deep diving.

You pounced on this I wrote "over there" as Morbius deftly referred to the place of less clubby but serious people who manage to tolerate such as I: " . . . gravity . . . comes into play as atmospheric pressure to help elastic rebound expel CO2 laden air after inspiration--that requiring little muscular effort in quiet breathing"

Wow, what do I see I bumbled into doing correctly as I learn a little of the BBCode, pasting stuff into Wordpad and trying to catch on. 'Will take a look at what I hoped might be constructive from Rubicon.

So not understanding what's happening here. PS is 3.4 cmH2O with EPAP range 9.2 - 16.0. It looks like baseline is running at 9.2 and peak pressure is at ~14.0 (max IPAP is 16.0) Then you got this glitch at where min PS would be (give or take)(coincidence?) but could also be what might be seen in the aforementioned improperly set Itime) (in this case, ~2.5 seconds).



At the least, pressure waveforms shouldn't have glitches, and seems to me exhalation is partially against increased pressure.

As an aside, if IPAPmax and EPAPmax are the same isn't is possible to end up creating a stone wall?

Well, I see some musing and will toss in what I know hoping to learn more and better. Hope never dies.

The PP is unusual for me, but does happen from time to time. I would have been using a P-10, mouth well sealed with Silipos Gel-E-Roll and its compressive retainer and a 4 in collar. Ti was 1 second, Te 2 seconds, the default VAuto settings, as are the Trigger and Cycle at Medium. AHI has been creeping up, maybe because of more and more supine sleep after quitting the absolute block of it . Regarding Ti, I happen to remember seeing, when wanting to check duty cycle, that Ti was flat on 1.0 second and quickly mosied away. Dunno about Te. On screen, long term, Ti is 1.3 and I:E 1:1.8 according to the VAuto. So, Ti, yeah not short enough if I understand you and the cracks in the mask pressure ramps down.

[Rubicon]

So all you got is

"Gravity is important if you got big bazongas."

and

"Use different crayons."

I think it's time to consider discontinuing life support.

[Rubicon]

However, I, a novice and other-forum experts, including geer1 with other proven (non-professional) experts , have seen prolonged instances of Resmed devices being totally confused about zero axis location

OK hold that thought.

Your coloring of your illustrative flow rate curve contrasts one normal breath cycle with the inspiration half and fractional spike of an expiration, not even one PP breath cycle. It suggests that only the inspiration and the starting spike of the PP expiration curve counted, not even the rest of that just that one illustrative E-wave lying below the axis. Your own first coloring example gave no indication any of the dozen or so whole PP-affected expirations were expirations.

Look at the difference between your "PP" and the original "PP". You have evidence of PP-influenced expiration, but the original, with an unwavering flow rate, has a defined, increasing value that strongly suggests it is not patient-related, but rather the aforementioned Resmed device zero axis confusion.

(Insert generic ad hominem assault here to make 2 paragraph post 6 miles long).

[Rubicon]

Morbius... PM soon.

Yeah that'll happen about a month after never.

[Rubicon]

But if you beg forgiveness and declare allegiance to The Sons and Daughters of the Satanic Following of Dial Wingers I'll tell you 3 ways to incorporate autonomic arousals to your Goldberg Machine.

[Rubicon]

However, I, a novice and other-forum experts, including geer1 with other proven (non-professional) experts , have seen prolonged instances of Resmed devices being totally confused about zero axis location and other flow metrics-

Well now I'm a little confused about that. On 3/9/2022 geer1 wrote:

The flow rates recorded by these machines are very accurate, I guarantee you they aren't confused about where 0 flow rate is.

So are you referring to like, now, after I proved to him that wandering baselines exist?

[palerider]

OTO, OH (IOWs, back to the original hand) that wouldn't explain this guy, where a pressure breath is sent in during obvious exhalation:



Gotta admit, that's a pretty good trick.

perhaps it hadn't passed the TiMin setting, if someone has diddled it away from the default 0.3 seconds.

[Rubicon]

Or maybe the breath prior to the little breath was "stacked" (no exhalation, no leak); an inadvertent inspiratory effort triggered a demand breath; then the exhalation of the stacked breath occurred against inspiratory pressure. In this case, the unerringly flat expiration was correctly placed on the -0- line (as is the ensuing flat expiration 2 breaths later). This would make sense as overall I = E.

I think you can do that occasionally, but not 9 breaths in a row.

That said, in the 9 breath, flat-lined PP example you got some major resuscitative breaths there, so while something's afoot IMO the flat expirations and baseline drop are too precise, you can't hide 3.0 L of inspiration, so that one probably had mouth leak in a nasal mask set-up.

Interesting to debate!

[AmSleepnBetta]

TVblip2slotMASKpDrop.GIF (34.36 KiB) Viewed 1051 times

This image adds little, but shows stacking and unstacking balancing over time. Uppermost the peak negative flow of expirations are shown. Too many generations of copies blur the image and, particularly the note stating grid lines are spaced 0.2 L, short arrows point to barely discernible dark spots on the 0-axis, indicating micro TV, and long arrows flag missing traces, whatever the reason.

[AmSleepnBetta]

Regarding missing traces indicated by longer arrows. The "pressure breath" instance would seem to suggest a limit level for resolution. The right-most long arrow another such possible indicator. Trouble is the middle arrow is missing with a definite dip in the pressure curve. More than meets the eye. Good to focus on and try to rationalize it. Clearly, the three long arrows mark the least depressions in the down ramps of mask pressure.