Newbie on AVAPS

[-SWS]

It probably isn't ResMed that needs the help. If ResMed were to build an AVAPS device I'm sure it would come with more AUTO features, or an AUTO BPM mode at a minimum.

Respironics could certainly add a few basic features to AVAPS to make it a more comfortable machine. AUTO BPM being the first feature.

I'm thinking both companies probably have some real interesting projects in the works!

[dsm]

SWS,

Good thought that is a saleable reason - this coming Sunday am off to NZ for 10 days minding - when back will try that line with Resmed

DSM

[-SWS]

SWS,

Good thought that is a saleable reason - this coming Sunday am off to NZ for 10 days minding - when back will try that line with Resmed

DSM

Best regards to Anne and family.

[Snoredog]

We want the Bipap S/T, SV, AVAPS, base unit (am sure they are all the same hardware) plus we want the ability to write our own mods to the
software to mix n match function & features for our own experimentation.

Many of us have been wondering why the heck manufacturers of biomedical equipment didn't just employ open source code from the very get-go. That way avid hobbyists of the medical arts would have a much easier time treating the general public with their own favorite medicinal hacks.

What on earth were those nutty manufacturers thinking when they secured their FDA-submitted algorithms for no good reason??? High-end cardiopulmonary biomed products really ought to be treated like public-domain consumer electronics. Those stinkin' corporate bastards!

J/K

They couldn't have that, people would hack them and figure out how to turn the blue lights off

[dsm]

We want the Bipap S/T, SV, AVAPS, base unit (am sure they are all the same hardware) plus we want the ability to write our own mods to the
software to mix n match function & features for our own experimentation.

Many of us have been wondering why the heck manufacturers of biomedical equipment didn't just employ open source code from the very get-go. That way avid hobbyists of the medical arts would have a much easier time treating the general public with their own favorite medicinal hacks.

What on earth were those nutty manufacturers thinking when they secured their FDA-submitted algorithms for no good reason??? High-end cardiopulmonary biomed products really ought to be treated like public-domain consumer electronics. Those stinkin' corporate bastards!

J/K

They couldn't have that, people would hack them and figure out how to turn the blue lights off

Snoredog,

Just imagine what a disgruntled programmer wife might be able to do to errant hubbys programmable xPAP.



DSM

[StillAnotherGuest]

1. Provide a optimal Average Tidal Volume without concomitant lung over-distention.
2. Mitigate periodic breathing associated with CSDB (Complex Sleep Disordered Breathing) and CSA (Central Sleep Apnea).
3. Mitigate upper airway anomolies including, but not limited to turbinate and septum restrictions.
4. Provide a solution for restrictive patients.
5. Provide a solution for COPD patients.
6. Provide a solution for CSR (Cheyenne Stokes Respiration) that may out-perform the SV.
7. (Possibly, but not confirmed) Provide a solution for morbidly obese patients.

This was my earlier summary of what I thought AVAPS could accomplish. I would probably have to eliminate Item 2 and Item 3 from the list.

As RG noted, you should get rid of Item 6, too.

And unless an Item 7 patient is an Item 4, they don't need this thing either.

SAG

[StillAnotherGuest]

And the more I think about it,

1. Provide a optimal Average Tidal Volume without concomitant lung over-distention.

should be off the Principles of AVAPS as well. Once you go to Volume-Controlled ventilation, then Pressure becomes variable, and "lung over-distension" automatically becomes a risk. That risk is controlled through the IPAP High Pressure Limits (in the case of AVAPS, IPAP Max).

Of course, the over-distension that we're talking about here is not the same as the patients in the "Protective Lung Strategies" articles. In generic Volume-Controlled ventilation for ARDS, huge pressures may be required, and the ventilators in those cases have High Pressure Limits of like 120 cmH2O.

SAG

[Banned]

1. Provide a optimal Average Tidal Volume without concomitant lung over-distention.
2. Mitigate periodic breathing associated with CSDB (Complex Sleep Disordered Breathing) and CSA (Central Sleep Apnea).
3. Mitigate upper airway anomolies including, but not limited to turbinate and septum restrictions.
4. Provide a solution for restrictive patients.
5. Provide a solution for COPD patients.
6. Provide a solution for CSR (Cheyenne Stokes Respiration) that may out-perform the SV.
7. (Possibly, but not confirmed) Provide a solution for morbidly obese patients.

This was my earlier summary of what I thought AVAPS could accomplish. I would probably have to eliminate Item 2 and Item 3 from the list.

As RG noted, you should get rid of Item 6, too.

And unless an Item 7 patient is an Item 4, they don't need this thing either.

I agree that AVAPS can only do two things:

4. Provide a solution for restrictive patients.
5. Provide a solution for COPD patients.

So, where is my Restrictive/COPD-SV machine?

Banned

[StillAnotherGuest]

I agree that AVAPS can only do two things:

4. Provide a solution for restrictive patients.
5. Provide a solution for COPD patients.

So unless you have a volume problem...

SAG

[Banned]

Responding to a thread from 'Sleepy55' and his new S/T, I re-tried the AVAPS last night. Results faired better than my previous random/chaotic trials.

My 10-21-08 AVAPS settings were:
Mode: S/T AVAPS
EPAP: 12
IPAP Min: 17
IPAP Max: 25
Tidal Volume: 620
BPM: 8
Inspiration Time: 2.1 Sec
Rise time: 4

My Encore results were:
Apnea Count: 85 (125 and up on previous random AVAPS trials)
Average Exhaled Tidal Volume: 645 ml (normally 500 ml on the Adapt SV)
Average Breath Rate: 15
Average % Patient Triggered Breaths: 97%
Average Leak: 44
Average Peak Inspiratory Flow: 42

I would like to lower the Apnea Count, if anyone has any ideas.

There may be something to the AVAPS recommendation of 8 ml Tidal Volume per kg of Ideal Body Weight. Even though 500 ml is still in the normal range, for some reason I have a tendency to jump out of bed in the morning refreshed and ready to go on 650 ml. And I maintain that level of energy all day. Placebo effect that will eventually wear off?

I finally figured out why the IPAP/EPAP switch was so noticeable.. Perhaps because of the increased Tidal Volume? Duh!

Banned

[Banned]

That went well. May have tamed the beast..

My 10-22-08 AVAPS setting were:
Mode: S/T AVAPS
EPAP: 13
IPAP Min: 19
IPAP Max: 25
Tidal Volume: 620
BPM: 6
Inspiration Time: 3 Sec
Rise time: 6

My Encore results were:
Average EPAP Pressure: 13
Average IPAP Pressure: 20.4
Apnea Count: 13.8
Average Exhaled Tidal Volume: 668 ml
Average Breath Rate: 14
Average % Patient Triggered Breaths: 97%
Average Leak: 43
Average Peak Inspiratory Flow: 37

Set EPAP Min 13 which is the highest EPAP setting I've ever used. Than set IPAP 19, Inspiration Time 3 Sec, and Rise Time 6, to blow through my obstructions (turbinate restrictions). Glad I pulled the AVAPS back out of the closet!

Banned

[Banned]

Ok, change of course, thanks to some stuff from Bev's thread. Having lowered my Apnea Count to 8 at EPAP 14 and IPAP Min 18, I'm going to run the AVAPS in S/T (only) mode for a week to baseline my BPM and Tidal Volume. That's right, no added VT. And I may use VT vary sparingly, if at all, at the end of this trial. So, tonight, its EPAP 14 and IPAP 17 to see if I can get the Apnea Count down to Adapt SV levels (<1).

I am curious as to why the Adapt SV can run at 3-4 cmH20 less than the S/T and give better results?

Banned

[dsm]

Ok, change of course, thanks to some stuff from Bev's thread. Having lowered my Apnea Count to 8 at EPAP 14 and IPAP Min 18, I'm going to run the AVAPS in S/T (only) mode for a week to baseline my BPM and Tidal Volume. That's right, no added VT. And I may use VT vary sparingly, if at all, at the end of this trial. So, tonight, its EPAP 14 and IPAP 17 to see if I can get the Apnea Count down to Adapt SV levels (<1).

I am curious as to why the Adapt SV runs can run at 3-4 cmH20 less than the S/T and give better results?

Banned

Banned,

From what I see the Vpap Adapt SV tracks volume & rate breath-by-breath & responds to volume variation very quickly & precisely (I believe it can do this because it uses that proximal sensor line). Good for some but I suspect not ideal for others - that sleeping lightly aspect of the Vpap Adapt SV was something I could never get away from. I have yet to meet or interact with anyone who says they sleep deeply using it.

I can understand your desire to get 'volume' but as far as I can tell, that can be achieved a number of ways. I don't believe your experimenting won't go astray, I would say it is giving you an increasing wealth of info that will fall more into place as you progress.

In thinking about how we sleep, it is pretty normal for volume to fluctuate if we move in our sleep. Weather change here (in Aust) has reminded me of how differently I sleep based on temp & weight of bed covers. Heavier blankets/covers will have me in deeper sleep. If you have a machine holding you to a target volume, it seems that there are going to be varying levels of competing with the machine based on factors such as how much you are moving in your current bed environment. My point here is "wondering if volume ventilation is a solution to someone else's problem" ?

I empathize with your nasal challenges. Luckily my own congestion/restriction is passing - maybe it was aggravated by us coming into spring. I am never sure.

Good luck with your testing. I may grab a night this w/e to try my quattro mask with the Vpap Adapt SV (haven't done this yet). Because it is so quiet (Adapt SV) I can get away with that type of experiment without getting read the riot act by wife

DSM

[Banned]

DSM,

I emailed you the AVAPS Provider Manual. Please upload it to this thread and make it available for the board to see, if you would. Take a look-see and tell me know the difference between 'S/T' (Spontaneous Timed) mode and 'PC' (Pressure Control) mode, when you get a chance. Or, anybody?

Thanks!
David

[dsm]

DSM,

I emailed you the AVAPS Provider Manual. Please upload it to this thread and make it available for the board to see, if you would. Take a look-see and tell me know the difference between 'S/T' (Spontaneous Timed) mode and 'PC' (Pressure Control) mode, when you get a chance. Or, anybody?

Thanks!
David

David,

Will do - I actually have a few provider manuals at http://www.internetage.ws/cpapdata/manuals/ - I'll add the AVAPS when I can locate it. (which email addr was it sent to ?)

Cheers

Doug

PS - The PB330 clin manual is an interesting read as to titration - very unusual procedure.