Please Help..Bi-PAP AVAPS - Calling SWS..

[unadog]

Unadog, I couldn't help but notice that you converted vikingblade's thread into a dial-winging campaign for Madalot. You admit you're too tired to read the details above, and yet you're more than happy to devise ventilation settings for patients on a message board whom you've never medically screened.

-SWS, I don't think that is completely fair.

I didn't mean to hijack the thread. But, as I mentionmed, Madalot had asked recently in another thread about changes she **had already made** to her Ti. I specifically **DID NOT** mention the changes she had made, or advise on numbers!

I just wanted to calculate the high and low parameters, based on your post, in a format that was a little easier to understand. The numbers were somewhat buried, and I thought the way that they were presented was somewhat abstract and difficult to understand. All I did was restate the same information that you had posted!

You yourself linked to a previous calculation of Madalots numbers.

My point was not that I didn't understand that part of tehg text. It was more that I had not had time to digest all of the posts, including the linked post, in detail, but thought it was useful to break out part of the information in an easier to read format.

as she is trying to optomize her settings (with help from her doctor and DME.)

Madalot is making the changes in conjunction with her DME and doctor. I did not advise at all in this thread.

[-SWS]

My apologies, Unadog... My wife is being diagnosed for health issues right now and boy does that have me feeling edgy. Please continue with your help if you don't mind.

[unadog]

Cheers -SWS. I hope everything turns out OK for your wife.

I'm sure she appreciates you being there for her. Sometimes that is all we can really do .... but it may be all she needs in some ways too. Someone to be there when we feel so alone. I am sorry.

Best wishes for you both.
Michael

[vikingblade]

thanks for the input guys. sorry for the late response, family issues are diverting my attention currently. i will read over everything, so i understand, and respond in detail soon. thanks again for the help. much appreciated.

[Madalot]

My apologies, Unadog... My wife is being diagnosed for health issues right now and boy does that have me feeling edgy. Please continue with your help if you don't mind.

-SWS,

I am so sorry to hear of this and will hold good thoughts that everything turns out okay. You give so much to the people of this board and know that it so appreciated. Please take care of your wife and yourself.

[juanbkm]

Reading this thread has been informative. I also got a PR System One BiPAP AVAPS last May and I really thought it was going to be an easy switch from the BiPAP Synchrony ST. Well a month into having it I still haven't been able to make the transition. I set the AVAPS to the same parameters as the Synchrony ST that I have but to no avail. It felt like I was not getting enough O2. I checked the machine with a manometer and it outputs pressure correctly. I have a feeling that the PR System One AVAPS gives air a little slower. When I breathe in my Synchrony I feel the IPAP kick in at once but in the AVAPS it feels like it's taking awhile to get to the higher pressure. I also checked with a pulse oximeter. With the same settings my O2 stats are lower on the AVAPS. It's only 94-95 comapred to 98 for the Synchrony.

I would really really appreciate any input as well. I'm desperate. It's not as if I can live without the machine during the day. I can't breathe without my BiPAP due to my neuromuscular disease. I'm using my Synchrony's now but i fear it may break and getting a machine here is not easy.

Here are my current settings:

IPAP - 15
EPAP - 5
BPM - 18
Ti - 1.6
Rise Time - 1

On the the AVAPS I tried setting it the same but it wasn't working for me so now here's my current setting which is a little bearable.

Mode - ST AVAPS
IPAP Min - 15
IPAP Max - 18
EPAP - 5
Tidal Volume - 300ml
Ti - 1.6
Rise Time - off

I'm pulling my hair out with this already. I'm not sure if it's a defective machine or it's really just not working as well as the old ones. Please help!

[-SWS]

I set the AVAPS to the same parameters as the Synchrony ST that I have but to no avail... When I breathe in my Synchrony I feel the IPAP kick in at once but in the AVAPS it feels like it's taking awhile to get to the higher pressure.

The AVAPS machine can be set up to operate exactly as your Synchrony ST operates. And a rise time of 1 should achieve the full IPAP pressure in 1/10th of a second on either machine.

I would suggest once again setting up your AVAPS machine EXACTLY as your Synchrony ST is set---to help determine if your new AVAPS is defective. An internal circuit leak, for instance, can cause IPAP to take longer to peak than your set 1/10th of a second.

Do you want to report ALL of your settings for both machines here? I would be more than happy to tell you whether I think your AVAPS is, indeed, set up identical to your Synchrony ST. If it turns out both machines are set up identically, and it STILL takes your AVAPS way too long to reach full IPAP pressure, then the machine will probably need to go back for warranty repair. That is assuming there are no external circuit leaks that are easy for you to fix...

[juanbkm]

Yes I would be more than happy to post the settings of both machines here. I really want to resolve this problem. What other information do you need? As far as I can remember here's the set up of both my machines now.

Synchrony S/T
IPAP - 15
EPAP - 5
BPM - 18
Rise Time - 1
Ti - 1.6s

BiPAP AVAPS
IPAP Min - 15
IPAP Max - 18
EPAP - 5
BPM - 18
Tidal Volume - 300ml
Rise Time - off
Ti - 1.6s

There's a memory card installed but I don't know what to do with whatever data is in there. I don't have any software to view it.

I did try setting it up as close to the synchrony as possible but still couldn't get it to be as good. Do you have any experience with the PR System One AVAPS? Is this a good machine? I thought it would be since it's from respironics.

Thanks for the help.

[juanbkm]

Oh, would be able to see if the machine is not peaking quickly by the data in the SD Card?

[Guest]

I'm not sure if it's a defective machine or it's really just not working as well as the old ones. Please help!

[Banned]

I'm not sure if it's a defective machine or it's really just not working as well as the old ones. Please help!

Your AVAPS machine is not defective.
Though it is counter-intuitive, if you set your AVAPS device to your old S/T settings you will come up short, as appears you have already done.
If you want some relief you will need to trial the following:
EPAP = 11cmH20
IPAP Min = 20cnH20
IPAP Max = 25cmH20

Are you a man, a woman, or not certain?
A tidal Volume of of 300ml sounds light.
How tall are you?

Banned

[juanbkm]

I'm not sure if it's a defective machine or it's really just not working as well as the old ones. Please help!

Your AVAPS machine is not defective.
Though it is counter-intuitive, if you set your AVAPS device to your old S/T settings you will come up short, as appears you have already done.
If you want some relief you will need to trial the following:
EPAP = 11cmH20
IPAP Min = 20cnH20
IPAP Max = 25cmH20

Are you a man, a woman, or not certain?
A tidal Volume of of 300ml sounds light.
How tall are you?

Banned

I'm a man. I'm about 5'6" but i'm only between 42 to 45kg depending on how much i've eaten hahaha I based the tidal volume on a couple of things. the 8ml/kg suggested by respironics and what the ti volume my bipap synchrony says i'm inhaling. in my synchrony i get it to about 280ml but the respironics guide says it should be around 350ml. so i started with 350ml.

i have pompe disease, which is a metabolic/neuromuscular disorder.

But if i set my AVAPS to the S/T mode with the AVAPS turned off it should work like my old Synchrony right? I tried that as well and set it to the same settings. I'm still dropping my O2 stats. I need to set it up as close to the synchrony as possible since I have to switch between machines. I'm on 24/7 ventilation and i need several machines.

thanks for the input. i really appreciate it.

[-SWS]

But if i set my AVAPS to the S/T mode with the AVAPS turned off it should work like my old Synchrony right? I tried that as well and set it to the same settings. I'm still dropping my O2 stats.

If they really are set up identically---in ST mode----then they should perform identically.

And if while set up identically in ST mode, IPAP seems to take much longer to peak and your O2 stats significantly plummet on the new machine, then that new machine needs to be checked by your DME.

[juanbkm]

But if i set my AVAPS to the S/T mode with the AVAPS turned off it should work like my old Synchrony right? I tried that as well and set it to the same settings. I'm still dropping my O2 stats.

If they really are set up identically---in ST mode----then they should perform identically.

And if while set up identically in ST mode, IPAP seems to take much longer to peak and your O2 stats significantly plummet on the new machine, then that new machine needs to be checked by your DME.

[vikingblade]

sorry ive been away from this thread so long. life can be demanding sometimes. thnx to everyone who has posted. unfortunately, im not much closer to solving this thing..had a bad nose bridge pressure sore..switched back to nasal pillows which caused major congestion because of high ipap pressures. no matter how high the humidifier settings. so..suffered with that while nose healed. then went back to mirage quattro with bandaid on bridge and worked on leaks. finally managing the mask pretty well and congestion has gone away. however, having difficulties with how i feel. and im still not sure what is the best settings for me. dr. and dme has given me the ok to adjust settings. problem is..neither seem very knowledgeable when it comes to the respironics avaps. to make matters worse, my situation is pretty unique and little variables seem to change things considerably. anyways, my current situation is below, as well as some questions..

over the last few weeks, i have felt the need to increase my ipap pressure. i was at 18 for a long time, and recently been having alot of difficulty getting a deep breath during the day and in bed. so.. went to 20, 22, 24.. now 26. it finally felt like i was being given a deep breath without me needing to assist much. however, after a couple nights at that pressure, i started feeling kinda strange during the day..shaky and feeling like i couldnt breath very well. so..when i felt that..i figured i needed a lil time back on the avaps..an hour here n there. felt better for a while after, but in short time, felt like i needed assistance again. im starting to think maybe im getting too much pressure...dunno. i always assumed using as much assistance as felt i needed was good. but, now...wondering if maybe im blowing off too much CO2. that my high ipap is causing low CO2 levels..i really dont know. problem is, if i lower my ipap much, i feel like i cant get a deep breath and need to help the inspiration. how do i know if my CO2 is too low... and what can i do setting wise to fix..

another thing.. i have my tidal volume at 600, but, ipap doesnt move a bit..thought it wasnt working. then started thinking.. maybe at my ipap pressures, im already over the 600. so..i looked at the monitor screens and saw something called vte..exhaled tidal volume.. im thinking this basically tells me what the tidal volume im currently at using my pressures..is this correct?? if so, my tidal volume is like 1100 at an ipap of 26! even when bringing ipap down to 20, i was still over 900. i had to drop ipap to like 15 to get to 600. and ipap pressures this low would never work for me. is this odd? could the machine be malfunctioning, or am i just reading this stuff wrong? does anyone know can i determine my approx tidal volume by my ipap pressure?? and how high is too high.. i understand how the epap is normally set..higher until obstruction clears. but, how is the correct ipap pressure found for someone like me...just increase until it feels good..its all kinda confusing

then there is the other variables.. my bpm are at 10, inspiratory time is 2.0, and a rise time of 5 feels best. i know with my neuromuscular disease weakness, i should be using an i:e ratio leaning more towards inhale, but, even after reading what has been written here, im still not really sure how best to do that except by making the inhale time, longer and longer.. i really cant seem to go higher than like 2.2 without it feeling suffocating. is there another way to get a more beneficial i:e ratio other than making my inhale time unnaturally long?? i read...-Set Ti between 33% and 50% for restrictive patients. 33% and 50% of what? can i get an example, im confused.

i know no one wants to tell me what to do, but, i will be experimenting with this either way. i would appreciate any input and ideas. SWS... could you please give an idea of what you would think a good place to start for my situation. my settings are below.. please throw me some ideas.. i mean, what can i do besides lowering my ipap min. i need some input. thanks again everyone. sorry if my thoughts seem scattered.. its tough to concentrate well when worrying about something as basic as breathing..kinda scary.

st avaps
tidal volume 600
ipap min 26
ipap max 30
epap 7
bpm 10
inhale time 2.0
rise time 5