Tidal volume and Flow limitations

[AmSleepnBetta]

negative effort dependence (NED)

Guide To Identifying Negative Effort Dependence (NED) With 95% Reliability

FL is lumpy on top - NED
FL is flat on top - not NED

Like in fixed obstructions.

ADDENDUM: For further reading:

https://www.thoracic.org/statements/res ... tudies.pdf
pp.1079-1080

Hmmm: "Identifying Negative Effort Dependence (NED) With 95% Reliability"

Don't you need to enlarge on "lumpy on top", if apt?

You left out other reserarch showing the distinguishing mark of NED in all your sage guidance. That can ybe chilling to those who, like me, have bountifully lumpy and M-tipped inspiration waves. Will look at your link, but know NED is defined elsewhere by no increase in flow with more downstream pressure if more negative pressure does not actually close the airway. Fortunately, most, if at all like me, do not ordinarily see inordinately high I-time and duty cycle ratio. (Quibbling expected)

[Morbius]

Just more gratuitous ordure from you.

Is there any other kind?

Obviously and charitably you have read ? little I've posted, preferring to call it unreadable and to sling mud and cast doubt to elevate yourself. It looks to be incurable "to the bone". You overlook (?) repeated guidance for finding duty cycle. My thing, the I-over-E graph, curve divergence, readout of chosen I and E time at the cursor, the formula.

What drives you? My most recent post you deride is an example where FL was only explainable with high duty cycle ratio.

Au ordure. mon ami, I have read everything you've posted since May 2021. I've also read everything that I've written (goes without saying)(but since I said it, it's too late) and I never said it was unreadable. The thought I wished to convey was that it was un-understandable (see? I knows big words too! OK, I make a lot of them up...)

Since I am a toothless, banjo-playing idiot from Sylva NC, can you point me to where I "deride an example where FL was only explainable with high duty cycle ratio" cause stuck out in my canoe somewhere (wait-- I'm not supposed to be in the canoe...)

However, if you're talking about the graph from 2/21 9:38 and this area:



I think I'd need to see an enlarged version to see actual I- and E-times, get rid of VT, add rate and expand it a little. Cause if I understand you correctly (although reread above) in the area where you identify conflict duty cycle actually remains constant, and all you got is a guy breathing slowly and deeply, as you might find in SWS.

Also, if you're going to talk about single breaths (BTW you spelled respectively wrong) I may have to retract my statement about accuracy. It looks to me like I: and E:time are also presented as a 5-breath moving average, so now you've got the same problem (or worse) that you have with tidal volume (note how when there's a problem, it's "you"?).

Nonetheless, duty cycle might have a place in analysis.

Pitch me.

[Morbius]

...as you might find in SWS.

Although given the time of night, more likely just some solid deuce.

[Morbius]

I think I'd need to see an enlarged version to see actual I- and E-time...

Specifically, wide enough to manually calculate I & E.

Cause it looks to me like the little stutter prior to inhalation is contaminating true I-time.

[Morbius]

you have to filter cardio to find I-time starts...

Yeah, so explain to me how you know that's cardioballistic artifact.

[Morbius]

you have to filter cardio to find I-time starts...

Yeah, so explain to me how you know that's cardioballistic artifact.

And if it is, then why, pray tell, didn't you filter it out it your I:E discussion?

Nor consider that your "discovery" of subtle flow limitation is simply additional CB contamination?

[Morbius]

but know NED is defined elsewhere by no increase in flow with more downstream pressure if more negative pressure does not actually close the airway. (Quibbling expected)

Yeah, more than quibble. That's incorrect. Instead of

no increase in flow with more downstream pressure

you get worse.

no increase in flow with more downstream pressure

is Starling.

[AmSleepnBetta]

Back again with busy images and opaque writing. My intent is to have helpful annotations on my graphics to reduce need to look at the forum message box. I've never polled for preferences, seen or heard them, but I find doing this work is easier and more accurate that way. Note: this stuff I post is a workbook spinoff from an interest I have pursued--still having VAuto treated FL and participated in arguments about meanings of Resmed FL.

Troll posts, alas: You may have scrolled through, read some and want to skip the next few paragraphs with my comments.

Here and now at CT, it's "Flood the zone, litter the thread, drive that ASB pest off, he might 'know something' PR and his posse doesn't and he uses too many 6-letter and even larger words."

The image below is a vertically zoomed copy of the one Morbidus duplicated, unnecessarily, simply to throw another "no TV drop stone" my way. He presents as technically adept, yet did not take seconds of time, in all his swashbucking brash "confidence?", to zoom, see and be honest about presence of--yes, sleep insignificant-- TV drops. The OP image, "guilty by association" with FL, is not clear cut, but PR was and is wrong in denying FL have any relationship to tidal volume drops.

Morbidus is hypocritical in sanctioning, even implicitly seconding PR in remaining silent about the ostensible leader PR's blunder--able silence is the cognizant voice of complicity. Morbius (Mbd) continually quibbles, scours my details to criticize and inflate any flaw he finds or manufactures. He either does not read before criticizing or ....? Cases on point: his claim I provide no actionable ideas or methods how to use info I post and his misrepresenting what I posted about the NED-TV-drop research paper.

I give it to Morbius: Fair enough: my writing, sadly, is obscure and my images too busy. The most recent one posted was an old image that needed updating with duty cycle (dC) concept newly in mind (FL driven by relatively longer I-time). I applied the newer-to-me dC concept to correct my image header attribution of FL duration and severity only to deformed wave shapes. (Its orange colored TVd drops need to be updated and increased too for the higher baseline TV I've noticed now--an earlier oversight along a path striving to understand and share/discuss what I and others see in OSCAR).

The graphic:

Main point: there are TV reductions caused by FL, possibly some by wave shape. The posted image I- and E-curve profiles eliminate duty cycle and RR factors.

It is a zoom of a graphic up thread from the OP thread starter, dataq1. It is my present best shot at dissecting and synchronizing time to show relationship of FL and TV reduction (TV drops, TVd). It relies on Morbius assertion that Resmed TV presented by OSCAR relies on a moving average of 5-waves which, at 13 breaths per minute, span 23 seconds. I simply show a special separate time line on that basis for my and readers' visual inspection and making mental adjustments--could have, I suppose, just snipped and pasted-in the time line curve itself to move it left 23 seconds . I don't know the centering or start of the 5-wave rolling average, but the 23 second shift has to improve

PR&Morbius-deny-TV-drop-at-a-FL.gif (414.05 KiB) Viewed 1501 times

on its lag in OSCAR graphs.

[Morbius]

Yeah, you're hanging on to that lie because that's all you got now.

Truth be told:

And BTW, you should untie the knot in your panties from this tirade

First, what a reach for PR's benefit! Aint't buying it if you say some remote FL you or he find, driven by wave shape alone, say, is going to prove his case that there is no connection between FL and TV.

The most charitable thing I can write is get your glasses checked to see TV reductions. And, no not all reductions: I am going to show only those marked accordingly, maybe a few extra. Go do equivalent legitimate work somewhere to present evidence and prove me wrong.

Because in actuality I didn't say palerider was right, nor did I say he was wrong. Specifically, I said,

... in many of the examples of flow limitation you and daquill have posted, no reduction in tidal volume occurs. And indeed, that's the whole purpose of increasing duty cycle, namely preserving tidal volume.

That said, you do have one example where there is tidal volume reduction in the face of severe flow limitation, but frankly, that flow limitation is so severe I would score that as a hypopnea (at the least).

But if you're asking me for my opinion (based on "Go do equivalent legitimate work somewhere") I need to respond with another "Well duh!" as FLs progress in severity through hypopnea and eventually to apnea, Vt eventually falls to -0-.

Duh.

That said, I wouldn't be putting a lot of stock in the accuracy of Vt measurements as they are extrapolated from the flow waveform. With about 30 L/M blowing by there (depending on what you're running) the margin of error is tremendous.

AAMOF if you ask ResMed it's +/-20%.

So I think it's great that you worked all night to come up with a 33 ml VT drop on a signal that's +/-20% and have to cut and paste to come up with some semblance of validity.

Rewrite Oscar! Balloons! Confetti!

But in any future references represent my position accurately, which is

as FLs progress in severity through hypopnea and eventually to apnea, Vt eventually falls to -0-.

[Morbius]

And if that's not clear enough, I will combine those 2 phenomena as:

During the progression of airway obstruction, tidal volume is initially preserved by increasing duty cycle. As FLs progress in severity through hypopnea and eventually to apnea, Vt eventually falls to -0-.

[jimbud]

Kinda of like watching a Peekapoo yapping at a Pit bull through a chain link fence.

Kinda cute, but futile and foolish.

JPB

[dataq1]

as FLs progress in severity through hypopnea and eventually to apnea, Vt eventually falls to -0-.

Intuitively that seems logical.
Contrary to opinions expressed very early in this thread (no relationship, relationship between pineapples and countertops, etc), Morbius you are verbalizing an inverse relationship between flow limitations and tidal volume. - And I have no argument with that.

The degree to which the reported grade of flow limitation (using Resmed's grading scale of 0, no flow limitation to 1, most severe) and it's quantative impact on tidal volume is certainly subject to discussion.

What my original post was about is how, in the face of increasing flow limitation grades, does the tidal volume remain fairly consistant. Maybe, just maybe, the Flow limitation grading scale max of 1.0 isn't really the most severe limitation to flow.

Another thought: Is there a Respironics analog to Resmed's Flow Limitation reporting?

[Morbius]

Contrary to opinions expressed very early in this thread ... Morbius you are verbalizing an inverse relationship between flow limitations and tidal volume. - And I have no argument with that.

One opinion, and IMO that misunderstanding has been corrected, so yeah let's move on.

AAMOF IDK why ASB is playing around with that measly 33 ml as I made his whole case for him on 2.19 with

where VT dropped to 61 ml on an FL run!!

+/-20% be damned that's one big MF drop!

I mean, I can make his case better than he can!

Hmmm.

I can make his case better than he can...

[Morbius]

I mean, I can make his case better than he can!

Hmmm.

I can make his case better than he can...

So if I claim that virtually everything ASB says is suspect;

and I can do that even better;

then logic dictates that my conclusions are even worse!

A syllogism that needs further investigation...

[Morbius]

So returning to the original image:



looking at the flow waveform, respiratory rate does not appear to change. It gets pretty scoopy, but that's it. However, respiratory rate doubles, indicating that RM is counting the scoops as 2 different breaths (not everything can be blamed on cardioballistic artifact, y'know!).

Consequently, Vt is wrong (it's probably more like 120 ml., but fine, that's still a significant drop), I:time is wrong, E:time is wrong, duty cycle is who knows, and tidal volume drop is yeah it does.

The pressure is correct tho.