AVAPS and end of life

avaps is a ventilator and is breathing for her, what were her wishes for end of life care. some want not to be kept alive without hope. The avaps can be turned off and let nature take its course.

Julie wrote:Does her doctor not say anything? A pulmonologist? The machine is not an actiual 'ventilator.'

Is she at home under hospice care, or in a hospital setting?

I'm so sorry for what you're going through.

It is a non invasive ventilator

xxyzx wrote:

George M wrote:Mom has been on AVAPS for four months now. This external ventilator is breathing for her. She is teminal COPD. Will the machine let her stop breathing if she is done? Of course it sounds an alarm when there is respiratory crisis and we react accordingly. She has stopped eating and drinking. We cannot find any information on the internet about end of life and breathing machines. The hospice nurse only says, "Everyone is different." Thank you for any helpful information.

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she is breathing not the machine
the machine only makes it easier

avaps wont force her to breathe and may alarm if she stops trying
ASV will force breaths if the patient stops breathing
invasive ventilation will breathe for them if they cant

no fluids and kidneys should fail in two weeks give or take followed by a painful death
i hope they are monitoring the pain and giving lots of pain meds and screw those who worry about some alleged opiod crisis

if they have the breathing machine in use
why didnt they do a feeding tube too ?

else why not pull the breathing machine too
and just administer lots of pain meds which is what hospice is supposed to do

what sort of information do you want about end of life and breathing machines?

some people sign papers so no machines or artificial things are used to keep them alive;
others want every possible expense taken to let them hang on for a little while longer;
and the other extreme is like california where 111 folks have already checked themselves out early this year to avoid the lingering and pain

my sympathy for having to see your mom like this.
we watched my wifes brother. fortunately he went within a week of entering hospice.

these are the time I find you really offensive with the ignorance you spout.

Please accept my deepest sympathies. I cannot begin to imagine this.

I am also using a Trilogy with AVAPS. I wish I knew the answer to your question for certain. My best guess is that the machine will keep doing its job until turned off, regardless. But as others have indicated, you should probably check with the professionals about that.

Again, I am so sorry.

I don't know have an answer either. However, I never heard of such an issue compounding the bereavement of a family.

I would guess that the machine would not be able to force breathing after death (remember, that's only a best guess based on very limited knowledge), and would not behave in an overlay "aggressive" way at that point.

xxyzx wrote:

robysue wrote:

xxyzx wrote:

George M wrote:Thank you so much for your consideration and questions. Obviously the more information that is available, the better the responses will be.

Mom is full-time on a Respironics Trilogy AVAPS.

that model is an ASV

No. The Trilogy AVAPS is NOT an ASV machine. It is a more complex machine that a typical ASV machine.

AVAPS stands for Average Volume Assured Pressure Support and it is a different algorithm than the ASV (Adaptive Servo Ventilation) algorithm. Loosely AVAPS automatically adapts pressure support to guarantee an average tidal volume. AVAPS are used when a patient (such as an end stage COPD patient) cannot maintain an adequate tidal volume, even if their breathing is nice and regular.

ASV machines are used to address the problem of central sleep apnea---i.e. their algorithm is used to prevent CO2 undershoot/overshoot cycles from developing in people who have no problems maintaining an adequate tidal volume when they are breathing at night.

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I READ THE WRITE UP ON IT
THEY SAY IT IS AN ASV

An ASV does Vt back up breathing

What else does it do that an ASV does not do

ASV was designed to handle central apnea when the patient does not breath by forcing a breathng rate and a Vt
but it doesnt care why you are not breathing
whether central apnea or dead it will keep trying to force a back up breathing rate on the patient

dont get confused by the different names manufacturers put on the same function

I am probably the ONLY regular member of this forum that actually uses a Trilogy. The Trilogy does a TON more than an ASV. It has more modes than you can believe, from basic CPAP mode to modes that are INVASIVE through a trach.

Comparing a Trilogy to an ASV is just stupid. They are not the same by any stretch.

xxyzx wrote:they all do tons more like cpap mode but ASV is not invasive
and this one is not invasive
so it is not doing tons more

it is acting like an ASV which is what the write up says it basically is

ALL ASVs can do more things

now if this one also hooks up via a tracheostomy then it does more things than vanilla ASVs but then it woudl be an E0472 not an E0471
but it is being used with a mask so even if it could work with invasive ventilation it is NOT being used that way

stop quibbling
this is an ASV being used as an ASV no matter what other stuff it could be used as

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

This end of alphabet boy produces more horse shit than a horse does.......but he will never admit it.

I think most of the regulars understand that the end of alphabet boy produces more horse shit than does a horse...I hope his bad information does not endanger any new members.

I admit I am a bit sensitive when it comes to the Trilogy. I've been using it since February 2010 and have had people here, proclaiming to be experts, tell me I am lying about what it does, modes, being on it, etc.

As to the OP's question, my feeling is that it will keep working until turned off, but alarms will sound when the patient stops breathing completely and alert them to the emergency. At that point, they will decide if the Trilogy needs to be turned off.

xxyzx wrote:

Madalot wrote:

xxyzx wrote:they all do tons more like cpap mode but ASV is not invasive
and this one is not invasive
so it is not doing tons more

it is acting like an ASV which is what the write up says it basically is

ALL ASVs can do more things

now if this one also hooks up via a tracheostomy then it does more things than vanilla ASVs but then it woudl be an E0472 not an E0471
but it is being used with a mask so even if it could work with invasive ventilation it is NOT being used that way

stop quibbling
this is an ASV being used as an ASV no matter what other stuff it could be used as

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.

xxyzx wrote:

Madalot wrote:

xxyzx wrote:

Madalot wrote:

xxyzx wrote:they all do tons more like cpap mode but ASV is not invasive
and this one is not invasive
so it is not doing tons more

it is acting like an ASV which is what the write up says it basically is

ALL ASVs can do more things

now if this one also hooks up via a tracheostomy then it does more things than vanilla ASVs but then it woudl be an E0472 not an E0471
but it is being used with a mask so even if it could work with invasive ventilation it is NOT being used that way

stop quibbling
this is an ASV being used as an ASV no matter what other stuff it could be used as

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.

=========

google is your friend

this does have features other ASVs dont have but except for the alarm they do not seem to be in use

all this quibbling is far from the central question of what should they do
which is ask what does the mother want done

Here's the thing - you're correct that this bickering back and forth is counterproductive to what the OP asked and needs.

But you are proclaiming things that are in dispute about the machine in use. You said you READ it. I told you I can't find it. I asked you to supply the link. If you refuse to post the link, then it does not exist. Which means you are spouting facts that you cannot prove. And all I'm asking you to do is pony up and prove it. If you don't, then you lied about its existence. And those are FACTS.

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.

Madalot wrote:

xxyzx wrote:

Madalot wrote:

xxyzx wrote:they all do tons more like cpap mode but ASV is not invasive
and this one is not invasive
so it is not doing tons more

it is acting like an ASV which is what the write up says it basically is

ALL ASVs can do more things

now if this one also hooks up via a tracheostomy then it does more things than vanilla ASVs but then it woudl be an E0472 not an E0471
but it is being used with a mask so even if it could work with invasive ventilation it is NOT being used that way

stop quibbling
this is an ASV being used as an ASV no matter what other stuff it could be used as

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.

xxyzx wrote:

robysue wrote:

xxyzx wrote:

George M wrote: Mom is full-time on a Respironics Trilogy AVAPS.

that model is an ASV

No. The Trilogy AVAPS is NOT an ASV machine. It is a more complex machine that a typical ASV machine.

========

I READ THE WRITE UP ON IT
THEY SAY IT IS AN ASV

WHO says the Trilogy AVAPS is an ASV machine? Cite a link to back up this ridiculous claim.

Details about the PR titration guide for both their ASV and AVAPS algorithms/machines can be found at http://incenter.medical.philips.com/doc ... %3d9792335.

Additional information about the AVAPS algorithm can be found at http://www.saegeling-mt.cz/fileadmin/us ... IntEng.pdf.

Additional information about the ASV algorithm can be found at https://www.aastweb.org/blog/what-is-asv

The first and most obvious difference is the intended group of patients for each device. Patients with central and complex sleep apnea are the targeted group for ASV. Patients with respiratory restrictive disorders and advanced COPD are the primary targets for AVAPS. The idea behind AVAPS is to make sure the pressure is sufficient to insure a target tidal volume even when the patient is breathing nice and regularly. The idea behind ASV is to provide respiratory support when the patient's breathing become irregular in a way that is characteristic of sleep apnea, and of central sleep apnea in particular. In addition, ASV is listed in the American Association of Sleep Technicians (AAST) material as not being appropriate for patients with severe COPD.

In other words, ASV and AVAPS machines are different machines used for different purposes.

xxyzx wrote:dont get confused by the different names manufacturers put on the same function

I'm not the one who is confused by the different names manufacturers put on the same function/algorithm.

Here is a list of PR and Resmed models that run either AVAPS or ASV. I've included web links for each machine so that you can find more information about all the PR and Resmed machines that fit the following categories of machines:

Home ventilators: These are real, full fledged ventilators that can be set up as either invasive or noninvasive vents. When used at home, these machines are billed under code E0465 or E0466, depnding on whether it is set up as a noninvasive vent or an invasive vent.

• PR ventilators. The Trilogy 100 and Trilogy 200. Both have a number of different ventilation modes, one of which is AVAPS.. The OP's dying mother is using one of these two machines in AVAPS mode.
• Resmed ventilators. The Astral 100, Astral 150, Steller 100, and the Steller 150. While all four can be used as either an invasive or noninvasive vent, only the Stellers use Resmed's iVAPS algorithm for encouraging spontaneous respiration. The Resmed iVAPS algorithm is equivalent to the PR AVAPS algorithm, and hence the Resmed Steller 100 or Steller 150 is the Resmed machine that is closest to the Trilogy the OP's mother is using.

Bilevel AVAPS/iVAPS: The target patients for these machines are people with restrictive respiratory problems, including severe COPD. These machines are considered non-invasive ventilators; I believe they are billed under E0471, but I don't know for sure.

• PR AVAPS. There are two commonly available PR AVAPS machines---the newly released PR DreamStation AVAPS and the older PR System One BiPAP AVAPS. Their AVAPS algorithm is the same as the AVAPS algorithm on the Trilogies.
• Resmed AirCurve 10 ST-A. This machine uses the same iVAPS algorithm that the Stellers use.

Bilevel ASV: The target patients for these machines are those with central and complex sleep apnea. These machines are coded under E0471.

• PR ASVs.There are two commonly available PR ASV machines---the newly released PR DreamStation BiPAP AutoSV Advanced and the older PR System One BiPAP AutoSV Advanced.
• Resmed AirCurve 10 ASV.

The Resmed web pages are more informative when it comes to describing the differences between their ASV and iVAPS machines than the PR web pages are. The Resmed AirCurve 10 ST-A and its iVAPS algorithm is advertised as providing "effective non-invasive ventilation for patients with respiratory insufficiency such as neuromuscular disease, restrictive lung disorders, severe COPD and hypoventilation syndromes." The Resmed AirCurve 10 ASV is advertised as providing effective treatment for " obstructive sleep apnea (OSA), central and/or mixed apneas, or periodic breathing."

In conclusion, AVAPS machines are not the same as ASV machines. They are designed to treat different problems and they have different algorithms.