Speaking of low arousal thresholds... (layman needs help)

[deltadave]

As to mounting PEEP valves while CPAPing I don't need the valve to be two ways because I get inhalation flow via the XPAP flow generator.

UFB.

Dave, if you don't stop shaking your head like that it's going to fall off!

Dan Quayle's words come to "mind" right about now...

[avi123]

...can I post the photo here?

You're really starting to creep me out. Are you gay (Not that there's anything wrong with that!)?

No, I wanted to show how smart you look but apparently devoid of clean language..

What you wrote above does not make sense. You posted: Provent has fixed Resistance, thereby resulting in Pressure varying in response to Flow.

Fifth Grade Math:

Reply,

So what if "Provent has fixed Resistance, thereby resulting in Pressure varying in response to Flow"?
And if it is correct how a PEEP valve works differently?

Pressure varies in reponse to resistance and not to flow, you smarty.

[SleepingUgly]

...can I post the photo here?

You're really starting to creep me out. Are you gay (Not that there's anything wrong with that!)?

Well, at least he asked this time. That part's good.

[SleepingUgly]

If Provent is a resistor, how do you create PEEP without a resistor? Don't they both use mechanical friction devices that reduce the air pressure and flow by turning the energy lost into heat?

If you convert the word air-Pressure to electrical voltage and the air-flow to electrical current then how could the electrical voltage be varied in response to the current when the current is passing thru an electrical resistance? May be you're talking about EMF (Electro Motoric Force)?

In a CPAP the air-Pressure is created and maintained by the speed of the blower, and measured at the outlet of the flow generator (the blower housing).

Is this one of those dreams where you realize you have a final exam today and you haven't been to class all semester? As it appears, I've been missing my engineering course where they explained how this flap that opens and shuts like a cuckoo clock in my nostril has everything to do with heat, electricity, and electro-other stuff. I am definitely going to get an F in this course.

[avi123]

If Provent is a resistor, how do you create PEEP without a resistor? Don't they both use mechanical friction devices that reduce the air pressure and flow by turning the energy lost into heat?

If you convert the word air-Pressure to electrical voltage and the air-flow to electrical current then how could the electrical voltage be varied in response to the current when the current is passing thru an electrical resistance? May be you're talking about EMF (Electro Motoric Force)?

In a CPAP the air-Pressure is created and maintained by the speed of the blower, and measured at the outlet of the flow generator (the blower housing).

Is this one of those dreams where you realize you have a final exam today and you haven't been to class all semester? As it appears, I've been missing my engineering course where they explained how this flap that opens and shuts like a cuckoo clock in my nostril has everything to do with heat, electricity, and electro-other stuff. I am definitely going to get an F in this course.

Comment,

When the expiration air is constricted by narrowing the nostril (by the device) then the local air pressure in the nose rises and stays above atmospheric (at 10 cm!) during the expiration period. However, the constriction causes the flowing air to raise its own temprature and the provent material also somewhat, similar to when you use a hand air pump to fill your bicycle wheel tire. You would not feel the Provent being heated b/c upon inspiration the cooler air cools those back. This has nothing to do with the improvement of respiration.

Those electrical equivalents that I mentioned to Dave of Pressure to Voltage, and air Flow to Current have nothing to do with the Provent operation.

If you are interested you can browse Provent's patent 7,506,649 here. Notice how many variations of shapes and types of Provents there are:

http://www.google.com/patents/US7506649

Click on: Download PDF

But the Provent guys have not invented its principal of operation. Only came out with variations of shapes and structures. And they apparently excelled in marketing.

[-SWS]

I don't buy Dr David Rapoport stories about the usefulness of the Provent more than the PEEP method which has been used for years in operation rooms by anesthesiologists and in ICU by the ventilators.

Avi, I don't understand your point-of-contention. I could be wrong, but I don't think Provent claimed to have invented resistance-based EPAP.

Mechanical PEEP was commonly used to keep the lower airway from collapsing. How would that application prevent Starling Resistor dynamics from applying to the upper airway? Since the upper and lower airways simultaneously inflate, the effects and potential benefits would not localize to one or the other. Lacking mutual exclusivity, we should expect applications for both the upper and lower airways.

I'm also confused how a discussion about a pair of pharmaceutical sleep aides got side tracked with an irrelevant Provent insertion.

[Zzzzzzzzzzz...]

I'm also confused how a discussion about a pair of pharmaceutical sleep aides got side tracked with an irrelevant Provent insertion.

Me too.

[49er]

I'm also confused how a discussion about a pair of pharmaceutical sleep aides got side tracked with an irrelevant Provent insertion.

Me too.

Me three.

I am also confused as to how asking a totally inappropriate question about whether someone is gay relates to the topic.

49er

[avi123]

-SWS , could you please explain the following by Delta Dave :

When Flow = 0 then Pressure = 0.

Is that true even with all the breath stacking and lung expansion/throat pulling that Dr. Rapoport talks about in his video?

By definition, if one is "breath-stacking", exhalation was still occurring when the ensuing inhalation occurred, so Flowexpiratory did not = 0.

Interestingly, this concept, when it occurs during Mechanical Ventilation, is known as "AutoPEEP".

As previously noted, a relatively high respiratory rate may be critical to create this phenomenon.

Deterioration of waveform during Provent therapy, apparently from slowed respiratory rate and loss of increased FRC:

and,

To the uneducated layperson, it would seem that Provent and "PEEP" follow the same princples. However, this is not so.

PEEP/CPAP/EPAP by definition have fixed Pressure regardless of Flow or Resistance. Provent has fixed Resistance, thereby resulting in Pressure varying in response to Flow.

Hence, the major drawback of Provent-- the Pressure is subject to wide variability

[-SWS]

Avi, may I suggest that you ask DD directly for any clarification you would like?

Regardless, I'll give you my interpretation of what I think he meant. In that first quote---the one you enclosed in a quote box---DD appears to make two main points in response to SU’s question: 1) patient “breath stacking” sometimes results in unintentional positive end-expiratory pressure called AutoPEEP, and 2) Provent can lose its ability to generate expiratory pressure in cases of untimely flow loss (he attributes slow RR and diminished FRC in the graphed example).

In that second quote by DD---the one you forgot to enclose in a quote box---he contends that Provent is not identical to ventilator PEEP after all. Avi, irrespective of whether Provent is identical to PEEP as you contend or just similar, my question remains:

How would PEEP's lower-airway benefits in any way prevent Provent's Starling Resistor dynamics from benefiting the upper airway?

[avi123]

Avi, may I suggest that you ask DD directly for any clarification you would like?

my question remains:

How would PEEP's lower-airway benefits in any way prevent Provent's Starling Resistor dynamics from benefiting the upper airway?

I don't think that I understand the question. But in any case It seems to me that I am benefiting from Provent/PEEP effects in my present nasal mask. The vent holes are so few and tiny that on expiration i feel my upper (nose) and lower airways (chest)stay inflated till the inhalation. And the treatment data results are unbelievably good.

[-SWS]

...the treatment data results are unbelievably good.

Avi, that part's excellent!

BTW, I like the new logo. Impressive company:
http://www.nesher.co.il/en/index.htm

[avi123]

...the treatment data results are unbelievably good.

Avi, that part's excellent!

BTW, I like the new logo. Impressive company:
http://www.nesher.co.il/en/index.htm

OOps, I need to change it now. I did not know that they still exist and using that logo!

[avi123]

...the treatment data results are unbelievably good.

Avi, that part's excellent!

BTW, I like the new logo. Impressive company:
http://www.nesher.co.il/en/index.htm

OOps, I need to change it now. I did not know that they still exist and using that logo!

It's against the law.