AVAPS-AE on MY Trilogy - Ongoing

[Pulmonette]

That resolution looks great. Can you post another comparison graph when there are no pulsations---same resolution, same pair of waveform channels?

How about a pressure tracing as well.

We need more Trilogy users...

[Madalot]

That resolution looks great. Can you post another comparison graph when there are no pulsations---same resolution, same pair of waveform channels?

How about a pressure tracing as well.

Pressure waveform WITH or WITHOUT pulses or both?

[Madalot]

Alright -- here we go. Here is what ~SWS requested:




Here is what Pulmonette requested. I did both with and without pulses since I didn't know which you wanted.



It has just occurred to me that with my computer behaving, I CAN go back and see if I can determine when my PTB started going down. Whether it was BEFORE the loaner machine or after. I will post about that when I figure it out.

[Madalot]

PTB Issue -- I got the loaner machine on 7/16/13. Interestingly, I do NOT have the average PTB for that day, but I looked at the 10 days before & after.

My Trilogy - AVAPS Settings
July 6 - 94.73
July 7 - 95.9
July 8 - 95.06
July 9 - 98.18
July 10 - 99.02
July 11 - 94.63
July 12 - 97.93
July 13 - 97.61
July 14 - 96.33
July 15 - 96.66

Loaner Trilogy- IDENTICAL AVAPS Settings

July 17 - 87.82
July 18 - 89.41
July 19 - 97.87
July 20 - 89.55
July 21 - 89.93
July 22 - 96.68
July 23 - 89.69
July 24 - 91.68
July 25 - 95.67
July 26 - 95.23

There have been days in August that have been in the low to mid 80's. Tidal Volume has never dropped below about 430 (target is 400).

I'm wondering if this machine has a problem.

[-SWS]

I'm wondering if this machine has a problem.

The two machines use different firmware levels. Backup criteria or interrelated/impacting treatment criteria might now be subtly different. Your tidal volumes look great using either firmware level. I wouldn't worry about small differences in PTB between the firmware levels. I would worry about PTB nose dives---the kind you had when you first turned on AVAPS-AE. Those are worth avoiding.

Assuming I am going to continue on this, should I go to Auto Trak next to see if that helps with the pulsing or should I go ahead and bump up the max EPAP next?

I think I'd favor a detour to explore Auto-Trak about now---to see if the firmware upgrade includes Auto-Trak enhancements that handle your breathing nuances better. More importantly, which do YOU prefer, Madalot? An Auto-Trak detour or continuation of your auto-EPAP exploration?

[Madalot]

-SWS, I think I'd like to run with your instincts and give Auto Trak a try. I'm assuming Auto Trak in AVAPS-AE, leaving the current settings of EPAP max at 10.

Sound reasonable?? Anything I should be aware of? It's been a long time since I tried Auto Trak.

[Madalot]

I just looked and saw there's auto Trak and auto Trak sensitive. Which one do I want?

[-SWS]

If it were me, I'd want to try them both. I'd pick one to try tonight, and then I'd try the other tomorrow night. If one of those two were a clear winner, then I'd continue with that choice for at least another night or two. If one seemed intolerable---or the least bit adverse in any way---then I'd revert to Flow Trigger, before the night was finished.

Ultimately, I'd want to settle on whichever of those three suited my breathing nuances best: Flow Trigger, Auto-Trak, or Auto-Trak Sensitive. I know in the past you settled on Flow Trigger (previous firmware) rather than Auto-Trak because you wanted the machine LESS sensitive...

[Madalot]

Wow. I didn't remember that! You know me and my journey better than I do!

I set it to Auto Trak for tonight.

[Madalot]

Well, Auto Trak was NOT too bad. Felt more natural and relaxed. Only out of sync a time or two, but certainly nothing I couldn't cope with. Pulsations during exhalation still there. Will check the data when I can get to the card (couple hours).

If data looks okay, will probably leave it on Auto Trak & the EPAP Max at 10 for a few days - despite these pulsations.

[Pulmonette]

Is the anti-asphyxiation valve on the mask working correctly?

[Madalot]

Is the anti-asphyxiation valve on the mask working correctly?

I have no reason to think it's not. But I have new valves/masks. Is there any way I could tell for sure if the valve is malfunctioning? Some behavior I could say "yes" or "no" about?

[Madalot]

Try to duplicate the exhalation and mask position that the pulsation occurred. The pulsation seems to occur only on exhalation, and slow and/or end-expiration at that. This seems contrary to any "normal" machine operation.

Also, any rainout?

Duplicating the exhalation & mask position would be very easy, but I'm not sure what you mean for me to do to test the valve. Sorry, just not following.

No rainout whatsoever.

[Guest]

Just try to duplicate all the variables that were in place when the pulsation was noted. The assumption is that it's not the machine, but rather something in the circuit. If you can get the pulsation going it should be easy to isolate the source (and 431 has been note to have AA valve incompetence).

[Madalot]

Just try to duplicate all the variables that were in place when the pulsation was noted. The assumption is that it's not the machine, but rather something in the circuit. If you can get the pulsation going it should be easy to isolate the source (and 431 has been note to have AA valve incompetence).

Okay. In order to duplicate it EXACTLY, I'll have to wait until this evening because my Trilogy is moved to the family room every morning, then taken back to the bedroom at night. However, what I *could* do is mask up this afternoon, in my recliner, and see if I get those pulsations.

Also, I have new masks so I could easily put a new mask into service tonight and see if that has anything to do with what's going on.

I woke up again early this morning with the pulses and noticed the time, so I can easily find it in the data again. But I'm not sure it matters because we've seen it. However, I did have Auto Trak going last night, so there is a minor difference. Don't know if this is relevant or not.