Ventilator Reports - Anyone Familiar with Them?

[Madalot]

I'm curious if anyone here is familiar with the software and/or reports from the ventilator. There are some things on the reports that I find confusing, but if no one here has ever dealt with them, there's no point in my spending too much energy asking.

Thanks in advance.

[-SWS]

A bump to see if we have any professionals who don't mind commenting on Madalot's Respironics DirectView reports for her Trilogy.

Thanks in advance if you can help!

[Madalot]

A bump to see if we have any professionals who don't mind commenting on Madalot's Respironics DirectView reports for her Trilogy.

Thanks in advance if you can help!

Thanks. One of the reasons I'm asking FIRST is that I haven't figured out how to post a report. I would need some education and/or direction in that regard. But there's no point in my going through that if there isn't anyone familiar with these reports to give me input.

And if nobody is -- that's okay. I'll deal -- but I thought I would ask.

[-SWS]

Do you have waveforms of your problem-areas when your RR drops and alarms go off? Despite unfamiliarity with DirectView, we still might be able to analyze those. More importantly, one of the professionals familiar with DirectView might see the charts and offer comments.

[Madalot]

Do you have waveforms of your problem-areas when your RR drops and alarms go off? Despite unfamiliarity with DirectView, we still might be able to analyze those. More importantly, one of the professionals familiar with DirectView might see the charts and offer comments.

No. All they gave me was the summaries this time. The first time they did a download, I received 40+ pages that did include actual waveform charts. They didn't provide it to me this time -- just the summary, which is the one I was going to ask about. I could probably ask them for a copy of the full report, but I'm not 100% positive they'll give it to me this time.

[ozij]

Hi Madalot,
Just another bump.
O.

[Madalot]

Hi Madalot,
Just another bump.
O.

Hi! Thanks for trying to bump this up for me. I was going to do it last night before I went to bed, but I never got back on the computer. I was hoping to get some input from the report before my appointment tomorrow, but I'm running out of time. Oh well. It was worth a shot.

I'll post a new thread after I see her.

[Madalot]

For those that are interested in what's happening and why I'm asking for input, I'll give you an idea of what the situation is.

The report that I was given this time only has a written summary. They didn't give me the entire thing that includes some of the graphs.

This report covers 73 days. That's over two months worth of information. The summary that has me perplexed lists the following information. It lists the Maximum, Minimum and Average for all of the following:

IPAP
EPAP
Breaths Per Minute
Patient Triggered Breaths
Peak Flow
Leak
Vte
Ti/Tot
Minute Ventilation
Apnea Count

Now here's where it gets tricky. It lists the numbers for all of these categories, but for a WEEK at a time. So the numbers I'm looking at, let's say Breaths Per Minute ('cause that's one of the ones that has me a little confused and/or concerned) look like this in the last two columns:

5/7/2010
Max 23
Min 2
Avg 12.21

5/14/2010
Max 24
Min 2
Avg 12.67

And if you look at the apnea count (something that Muffy was very confused about because of the number) ranges from 2650 under the colum for 3/5/2010, but goes down every week and the last week shows 345. Remember: this information is being provided for a WEEK, not a day.

I'm taking my copy of the report with me and will ask my doctor about it. But I'm not positive she'll be able to explain it to me like you guys here do.

[cflame1]

Madalot... if you have a scanner (or some way of getting it scanned), then create a .jpg of each page and load it into photobucket. Those directions could be different if you use a different site, but photobucket is what a lot of us use.

From there it will give you an address for each page. Use the IMG button to put IMG tags around the address if you want to do a picture or the URL button if you just want to point to a location.

Does that part help?

[Madalot]

Madalot... if you have a scanner (or some way of getting it scanned), then create a .jpg of each page and load it into photobucket. Those directions could be different if you use a different site, but photobucket is what a lot of us use.

From there it will give you an address for each page. Use the IMG button to put IMG tags around the address if you want to do a picture or the URL button if you just want to point to a location.

Does that part help?

Oh yes -- this is very helpful. I had figured out some of it, but the photobucket part was the one I didn't know. I figured the report/graph needed to be scanned (I've done that, but there's a problem) and then put somewhere so I could post a link.

Does Photobucket charge for this service?

The problem I have is that the summary report covers 11 weeks and lists them straight across -- the print is SMALL. Very small. When I scan it, the only way I could scan it so I could read it was to make it a PDF file. I could probably play more and tweek it more to get it as an image file (.jpg) that could be readable, but I'm just running out of time to get this accomplished before my appointment tomorrow.

But this is very helpful for future reference. Thank you!!

[Madalot]

Okay -- here's the summary report. I know it's small, but this was the best I could do because the report is so darned small.

This is what they're giving me. After some of the experts/professionals look at this, can you see why I'm a little confused?

[-SWS]

Well, if those apnea counts are for each week, then your recent apnea numbers especially aren't so bad. Too bad the summary doesn't list average hours slept. Still, let's calculate a range of likely AI, assuming you slept between 7 and 9 hours on average:

3/05 week @ 2650 apneas: AI probably averaged between 42 and 54
3/12 week @ 2742 apneas: AI probably averaged between 44 and 56
3/19 week @ 1636 apneas: AI probably averaged between 26 and 33
3/26 week @ 1338 apneas: AI probably averaged between 21 and 27
4/02 week @ 1759 apneas: AI probably averaged between 28 and 36
4/09 week @ 0802 apneas: AI probably averaged between 13 and 16
4/16 week @ 0740 apneas: AI probably averaged between 12 and 15
4/23 week @ 0720 apneas: AI probably averaged between 11 and 15
4/30 week @ 0639 apneas: AI probably averaged between 10 and 13
5/07 week @ 0827 apneas: AI probably averaged between 13 and 17
5/14 week @ 0345 apneas: incomplete week at data-collection point

I suspect that Respironics reports both apneas and hypopneas in that single category they call "apnea". But you can definitely see an improvement as the weeks progress---likely as your body acclimates to the ventilator.

Madalot, was 4/09 your first full week with Ti set at 2.0s?

[Madalot]

-SWS,

Okay, I DO have a little more information based on what you're asking me.

I don't remember exactly when we changed the Inspiratory Time to 2.0, but that date sounds about right. I might be able to check the ventilator itself and see if there's still a record of it in the history. I'll do that the next time I go back, but let's assume that date is correct.

My average usage per night is 7hrs 32mins. The report they gave me has a chart of DAILY usage. From 3/5 - 5/17, the most was 10 hrs, 39 mins (I slept late that morning) and the least is 0 (a night I didn't use it at all -- I was doing my own overnight on room air test to see what my monitor would show). But for nights used, the shortest time was 6hrs, 15mins.

And you ARE correct that the apneas do appear to be lessening each week. I think it would be a safe assumption that I'm starting to adjust to the ventilator.

But -- one of my biggest questions is the alarms. I haven't tried them lately, but the last time I did, the apnea and low tidal volume still went off numerous times during the night. Maybe I'm missing something, but if I'm receiving effective treatment, shouldn't we be able to set those alarms and NOT have them go off at least 6-10 times each night? Or am I just being dense?

[-SWS]

But -- one of my biggest questions is the alarms. I haven't tried them lately, but the last time I did, the apnea and low tidal volume still went off numerous times during the night. Maybe I'm missing something, but if I'm receiving effective treatment, shouldn't we be able to set those alarms and NOT have them go off at least 6-10 times each night? Or am I just being dense?

I don't think you're being dense... But since I share that same opinion, my answer is undeniably going to be biased.

But I still stand by this opinion in your recent thread, Madalot:

...the current goals IMO should be to diligently optimize vent settings and find methods to improve sleep despite the cumbersome machine.

Madalot, was 4/09 your first full week with Ti set at 2.0s?

I don't remember exactly when we changed the Inspiratory Time to 2.0, but that date sounds about right. I might be able to check the ventilator itself and see if there's still a record of it in the history. I'll do that the next time I go back

I found your old thread, Madalot. As it turns out, your first full week with Ti=2.0s was that prior week when AHI spiked a bit. So it's not a foregone conclusion that Ti=2.0s improved your ventilation. You have been beneficially adapting to the ventilator all along, and that just might account for all your recent improvement for all we know.

Are you sure it's not feasible to head back into the lab for an AVAPS S/T titration? I'm thinking they should be able to come up with better titration results for you---now that your body feels acclimated to the vent. I recommend that you reconsider a PSG for a round of tweaks since your DME currently does not have an RT to facilitate at-home tweaks. You've never had a PSG for this machine so they owe you one...

[MidnightOwl]

Madalot,

I hope the doctors visit today goes well.

Perhaps, along with everything else, you can find out what the alarms should be set at, if they need to be on at all for your condition since you're not a typical vent user. If they are anything like the alarms on the ventilator I've encountered they are too *@#$^% loud.

Midnightowl