AVAPS and end of life

[robysue]

all i see in the OP is the backup rate like the ASV provides

OP specifically said his mother was using AVAPS mode, which is distinctly different from ASV mode. You, and only you, are claiming the OP's mother is using ASV mode.

different machines for different purposes
overlapping capabilities

Yes, there are overlapping capabilities: An AVAPS machine can set up to run in ASV mode, but an ASV machine cannot be set up to run in AVAPS mode.

and the first manual i found said it was asv

Which manual and where did you find it? You (NOT me) are obligated to provide that link if you want people on the forum to take your comments seriously.

it may be more but it is definitely asv
just like it could be set for cpap or something else too

You are confusing the issue.

The OP's mother is using a Trilogy ventilator in AVAPS mode.

Yes, the Trilogy can be set to run in ASV mode, but that is irrelevant since the OP's mother is using a Trilogy in AVAPS mode.

the point is that if they are not using that special stuff then it does not matter if it can do more

You haven't any idea of what settings are being used. Hence you have no idea what "special stuff" is or is not being used. All we have been told the mode is AVAPS, and AVAPS mode is NOT the same as ASV mode.

[Madalot]

My thanks to robysue for posting all the information in the above post. I know it's 100% accurate because she knows her stuff, plus I have a lot of experience with the Trilogy.

I went to Phillips website and NOWHERE does it say that the Trilogy is essentially an ASV. NOWHERE. That's why I asked for the link because unless you cough it up, it does not exist. More likely than not, your claim is simply your interpretation of what you read.

Your obsession with ASV machines is half scary, half comical.

[Madalot]

all i see in the OP is the backup rate like the ASV provides

OP specifically said his mother was using AVAPS mode, which is distinctly different from ASV mode. You, and only you, are claiming the OP's mother is using ASV mode.

different machines for different purposes
overlapping capabilities

Yes, there are overlapping capabilities: An AVAPS machine can set up to run in ASV mode, but an ASV machine cannot be set up to run in AVAPS mode.

and the first manual i found said it was asv

Which manual and where did you find it? You (NOT me) are obligated to provide that link if you want people on the forum to take your comments seriously.

it may be more but it is definitely asv
just like it could be set for cpap or something else too

You are confusing the issue.

The OP's mother is using a Trilogy ventilator in AVAPS mode.

Yes, the Trilogy can be set to run in ASV mode, but that is irrelevant since the OP's mother is using a Trilogy in AVAPS mode.

the point is that if they are not using that special stuff then it does not matter if it can do more

You haven't any idea of what settings are being used. Hence you have no idea what "special stuff" is or is not being used. All we have been told the mode is AVAPS, and AVAPS mode is NOT the same as ASV mode.

Robysue, as usual, is correct. I am using the Trilogy in S/T with AVAPS (not be confused with AVAPS-AE). There are TONS of special settings to tweak what the Trilogy is doing. And, there is no specific ASV mode (unless it's been added recently, which I will check later). There may be modes that mimic ASV, but to the best of my recollection, there isn't a specific ASV mode. I will look later and if I'm wrong, I'll come back and correct myself.

[Cardsfan]

I just want to say I am sorry for what your family is going through. And I am sorry some of the posters on here are so insensitive as to bicker back and forth on this thread. You know who you are, and should be ashamed. There is a time and place and this thread isn't it.

[Madalot]

I just want to say I am sorry for what your family is going through. And I am sorry some of the posters on here are so insensitive as to bicker back and forth on this thread. You know who you are, and should be ashamed. There is a time and place and this thread isn't it.

You are 100% correct. I believe the OP is NOT reading now anyway, having gotten his/her answers and is focusing their attention where it needs to be - on their mother. I doubt seriously they are seeing any of this.

But I will take the chastisement, deservedly, and if this needs to continue, it should be moved elsewhere.

I started a new thread - and I apologize to the OP if they see this. I'm truly sorry for what you are going through and participating in the argument in your thread. I sincerely apologize.

[ajack]

Sorry - you are wrong on this one. ASV & AVAPS are NOT the same thing. Similar, but NOT the same.

They would not have put this woman on a Trilogy if an ASV would have sufficed. The Trilogy is way more expensive and takes regular visits by an RT for monitoring (even me - RT comes once a month). There is no reason to give a patient a Trilogy to do the job of an ASV. And trust me, they wouldn't do it.

viewtopic/t37261/AVAPS-vs-ASV.html

whatever dood
i read the write up by the manufacturer
they say it is an SV
it certainly works like an ASV

she has copd so maybe they used the fancier machine because of that
the fact is that it is helping her breathe
and it will breathe for her if she stops whether central apnea or other cause

I read the literature I found and did not see what you are describing. Please provide the link.

an ASV falls below a ST, let alone a ST AVAPS on the scale of machines modes. Because manchild is getting an ASV, it has to the best machine mode ever.
Don't expect a sensible answer, the guy is incapable of logical thought, there won't be a link, there can't be, because he's just being the village idiot, misunderstanding anything he reads.

=======

as usual ajackoff is wrong
and is illogical as well as disrepectful but that is what libtards are

ASV is used after an ST fails accordign to my ex DME that quoted medicrap rules

the avaps in question has more capability than mere ASVs but is still being used like an ASV with BU rate breathing

You are making this up, no DME would say an asv comes after a fail in ST. a ST and avaps comes after an asv fail. Even they aren't this silly.
but now you are making a statement that there is a medicare rule for this, I suggest you post it

[raisedfist]

If she is using a mask, meaning non-invasive ventilation, then the Trilogy is simply assisting with breathing; the AVAPS mode just ensures adequate ventilation (assuming everything is set correctly). If she was sedated and/or unable to protect her airway, then she would be using invasive ventilation.

=====

and that is exactly what an ASV does

when the patient is not breathing it forces a RR and a given Vt
resmed and philips have different algorithms to determine RR and Vt
some machines let the dr. set the RR
the Vt really depends on the patient and their lungs so setting an average for everybody would not be as good as using the patients own Vt average

No. The ASV responds breath by breath and prevents over/under shoot of minute ventilation. Breath by breath = servo ventilation. AVAPS DOES NOT do that.

An ASV is for central/complex apnea. The algorithm works for the predictable types of breathing irregularities. It's not meant to respond to the erratic breathing patterns of someone with severe respiratory disease.

AVAPS is a MUCH MUCH slower algorithm and targets an AVERAGE tidal volume that you set differently for each person - based on HEIGHT AND IDEAL BODY WEIGHT. They are not the same. An ASV is NOT appropriate for someone with a neuromuscular disease or obesity hypoventilation syndrome. Further, an ASV would be TERRIBLE for someone with COPD due to hyperinflation.

"ASV is NOT for the following types of patients:
Those who have chronic and profound hypoventilation.
Those who have moderate to severe chronic obstructive lung disease.
Those who have chronically elevated partial pressure of carbon dioxide on ABG (arterial blood gas) (> 45 mm Hg).
Those who have restrictive thoracic or neuromuscular disease."

"ASV's pressure target is adjusted according to the input from the patient. What that means is that the target is not a fixed value but rather adapts to the patient's breathing patterns." So, an ASV targets the patient's actual ventilation, which is INADEQUATE for people suffering from HYPO ventilation.

Which would be a DISASTER for people with COPD and other respiratory diseases. Their breathing patterns (often even while awake) are SUB OPTIMAL, hence the point of AVAPS - to ensure adequate ventilation, regardless of respiratory changes during sleep. The goal of AVAPS is re: adequate ventilation. The goal of ASV is to treat central/complex apnea. AVAPS basically adjusts pressure support up and down to reach the target tidal volume set. The target tidal volume is obviously not the same for someone 60 inches tall as it is for someone 72 inches tall.

AVAPS has a backup rate in the S/T mode because people using it often fail to trigger the device while sleeping (mostly in REM sleep, at least early on in the disease process) due to muscular weakness, AND because often they cannot maintain an adequate respiratory rate while sleeping. At least the first reason does not apply to people using the ASV.

[ajack]

you just don't understand what you read or what people tell you, including your DME.
adaptive servo ventilation isn't the same as a servo ventilator. An ASV can't sustain a volume. It is variable and copies the last few minutes. If the volume becomes low, the ASV will duplicate this and will be insufficient. I posted my ASV chart on the other thread to show this.

you see unlike you, I actually use an ASV and a ST machine
http://i.imgur.com/YGRaSjh.png

[Madalot]

PLEASE MOVE THE DISCUSSION/ARGUMENT TO THE OTHER THREAD. GIVE THE OP some peace please.

Thank you.

[raisedfist]

If she is using a mask, meaning non-invasive ventilation, then the Trilogy is simply assisting with breathing; the AVAPS mode just ensures adequate ventilation (assuming everything is set correctly). If she was sedated and/or unable to protect her airway, then she would be using invasive ventilation.

=====

and that is exactly what an ASV does

when the patient is not breathing it forces a RR and a given Vt
resmed and philips have different algorithms to determine RR and Vt
some machines let the dr. set the RR
the Vt really depends on the patient and their lungs so setting an average for everybody would not be as good as using the patients own Vt average

No. The ASV responds breath by breath and prevents over/under shoot of minute ventilation. Breath by breath = servo ventilation. AVAPS DOES NOT do that.

An ASV is for central/complex apnea. The algorithm works for the predictable types of breathing irregularities. It's not meant to respond to the erratic breathing patterns of someone with severe respiratory disease.

AVAPS is a MUCH MUCH slower algorithm and targets an AVERAGE tidal volume that you set differently for each person - based on HEIGHT AND IDEAL BODY WEIGHT. They are not the same. An ASV is NOT appropriate for someone with a neuromuscular disease or obesity hypoventilation syndrome. Further, an ASV would be TERRIBLE for someone with COPD due to hyperinflation.

"ASV is NOT for the following types of patients:
Those who have chronic and profound hypoventilation.
Those who have moderate to severe chronic obstructive lung disease.
Those who have chronically elevated partial pressure of carbon dioxide on ABG (arterial blood gas) (> 45 mm Hg).
Those who have restrictive thoracic or neuromuscular disease."

"ASV's pressure target is adjusted according to the input from the patient. What that means is that the target is not a fixed value but rather adapts to the patient's breathing patterns." So, an ASV targets the patient's actual ventilation, which is INADEQUATE for people suffering from HYPO ventilation.

Which would be a DISASTER for people with COPD and other respiratory diseases. Their breathing patterns (often even while awake) are SUB OPTIMAL, hence the point of AVAPS - to ensure adequate ventilation, regardless of respiratory changes during sleep. The goal of AVAPS is re: adequate ventilation. The goal of ASV is to treat central/complex apnea. AVAPS basically adjusts pressure support up and down to reach the target tidal volume set. The target tidal volume is obviously not the same for someone 60 inches tall as it is for someone 72 inches tall.

AVAPS has a backup rate in the S/T mode because people using it often fail to trigger the device while sleeping (mostly in REM sleep, at least early on in the disease process) due to muscular weakness, AND because often they cannot maintain an adequate respiratory rate while sleeping. At least the first reason does not apply to people using the ASV.

========
carrots and kumquats

if you are not breathing
the ASV starts a RR with your Vt and keeps pushing air in until you do start breathing again

you keep thinking it doesnt do that and you need something fancier

you are just stuck on trying to prove something entirely pointless and irrelevant.

straight from ResMed titration guide:

"ASV Technology
For normo/hypocapnic, hyperventilating patients"

AKA, not for OP's mom since she has severe COPD, AKA severe hypercapnia. AKA your "it's the same thing" ASV would make her even worse.

"The only ASV technology to target the patient’s own recent minute ventilation"

the patients own breathing during hypoventilation is highly inadequate, so you'd be targeting an inefficient ventilation rate. AKA making her worse.

Just stop already.

[robysue]

moved to the other thread at madalot's request

[Julie]

Yes... but I didn't know how to describe it well, just knew it wasn't the usual major one used in hospitals.

[chunkyfrog]

We need to learn to address the original question without getting bogged down with minutiae, or another pissing match.
A kid is losing his MOTHER!
It might be appropriate to give a shit about that, and then drop the other "party".
Those of us who have lost a parent can recall how painful that can be.
We can help a little, so let's just do that, please.

[Madalot]

Keeping the OP in our thoughts.