Little Larissa - please read

birdshell · Post by **birdshell** » Sat Jul 26, 2008 9:48 am

WELCOME! It is always wonderful to read posts by our fellow hoseheads from around the world. It enriches our experiences.

This may be a really positive thing for you, too, because we once had a primarily French-speaking Canadian with whom it was hard to communicate...because no one had learned the French words for all of this CPAP-specific discussion. Being a newbie, our French Canadian hadn't learned the English words!

Perhaps you will be saved that problem through Laryssa's posts on this thread?
_________________________________________________________________________

And to my fellow CPAPtalkers, are you thinking what I'm thinking???

Another awesome interpreter!

Best wishes and great name.

Karen,
Who wishes she spoke Portuguese

dsm · Post by **dsm** » Sun Jul 27, 2008 2:35 pm

cpaped,

Welcome to cpaptalk, a virtual community able to interact through the wonders of modern technology

It is very pleasing to see newcomers from such diverse cultures finding common ground here and ways to help each other.

Laryssa's situation has touched many people around the world.

Welcome!

DSM

brazilian · Post by **brazilian** » Wed Aug 06, 2008 5:22 pm

Hi, everybody!

I've just returned from Mexico, with some spare cushions for Laryssa. She was already using the hospital mask, which gave her a sore nose bridge again... I have no idea why didn't they use the other mask, which seems has been staying in the ICU until now. Anyway, tomorrow I will be attending the weekly meeting, as I was invited by Dr. Vergara, and will make things clear on that.

Today I went to the infirmary to see Laryssa, and replace the cushion, and give her some gifts sent by SWS & Karen... Also, I got the card for the readings.

Recent reports can be seen at: http://www.baumgratz.eng.br/laryssa/rep ... 080806.htm

or downloaded at: http://www.baumgratz.eng.br/laryssa/rep ... 080806.pdf

Below are some pictures...

Blue kisses to all!

July, 18th - Sleeping...

July, 18th - Laryssa's room

August, 6th - Sending a kiss to Uncle Steve...

August, 6th - smack...!!!

August, 6th - new cushions...!!!

Thanks, Karen...!!! First Crayola dough ever...

Astronaut...!!!

"I loved 'Puff'!..."

Not an Astronaut... a biker...!!!!

-SWS · Post by **-SWS** » Wed Aug 06, 2008 6:52 pm

That's our style-with-a-smile gal alright!!! ...Our daring biker, our exploring astronaut, our youngest and boldest kindred-spirit of the hose! A true princess for sure!

Thanks so much for posting those, Sir Brazilian!

.

mellabella · Post by **mellabella** » Wed Aug 06, 2008 8:22 pm

She's the only person I've ever seen who manages to make a CPAP mask look just adorable.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap mask

ozij · Post by **ozij** » Wed Aug 06, 2008 8:58 pm

Thanks Nelson.
O.

birdshell · Post by **birdshell** » Wed Aug 06, 2008 9:21 pm

The captions are very well done, and the pictures even better! Thank you for sharing them with us.

What Laryssa does:

What Laryssa pretends she is doing:

She certainly communicates through them and seems to have quite a personality. Of course, we all knew THAT already.

It is sad, though, to see her moleskin (?) on the bridge of her nose. It is a good thing that you are there to ask about the masks. I am glad that you are invited to go to her conference.

Sincerely,
Karen

dsm · Post by **dsm** » Thu Aug 07, 2008 5:45 pm

Nelson,

As always - many thanks for the pics - they are so welcome

DSM

dsm · Post by **dsm** » Thu Aug 07, 2008 5:59 pm

Some quick comments on Laryssa's charts.

The av tidal vol appears to be higher that we saw on earlier charts (good) - she does have a few short periods where it dips very low but not as many as before.

Also I see that whilst there is no IpapMAX setting showing (black bar), the machine seems to exceed the Ipap (IpapMIN) setting quite a bit ? - am not sure if this means that the machine is running as a bilevel (Epap = 7 Ipap = 16). The report is showing the 16 CMs as the Av Peak Ipap (orange bar) but showing IpapMIN as somewhere around 12 CMs (pink bar).

Am guessing the machine is running at 7/16 & that the report is confusingly calling the 16 CMs 'Av peak Ipap' when it should be calling it IpapMIN or IpapMAX or Ipap MIN/MAX (both set the same).

DSM

brazilian · Post by **brazilian** » Thu Aug 07, 2008 6:14 pm

DSM, in fact, the machine is set as bilevel, as I was told today by Dr. Vergara.

Since the machine is the only one in Brazil, they still have some doubts and are trying to figure out how it works, so they set it like that. He asked me to post these questions:

1. How does the algorithm defines the inspiratory pressure?

2. Based on what does the program determinate if pressure will be max or min? For instance, if ipap max =18, and ipap min=15, why will it choose, say, 15, and not 18...?

In AVAPs there is a goal, which is the current volume. He is trying to understand how dos this BiPap handles that.

I am sorry if I can not be more clear than that, I must confess my total ignorance (by now) on all this technical discussion (although there's lots of info in this forum, it is just that I really have had not the time to study the subject in depth as I wished).

Answers may be already posted in this thread, or in another one, but what Dr. Vergara asked me today is to be his interlocutor with all you experts, in order to allow him to fully understand this BiPap "way of thinking". He is as busy as one doctor can be, and still have some difficulties with the language, so I would bother you on that...

thanks....

Banned · Post by **Banned** » Thu Aug 07, 2008 7:02 pm

DSM, SWS, RG, SAG, Others?

Banned

Banned · Post by **Banned** » Thu Aug 07, 2008 9:32 pm

Ok, I'll start. The BiPAP Auto SV algorithm functions as follows:

1. The BiPAP Auto SV delivers minimum pressure support determined by EPAP and IPAP controls.

2. There is no provision and no way to simulate an assured average volume with the BiPAP Auto SV (e.g. AVAPS).

3. When the BiPAP Auto SV controls are set for EPAP < IPAP Min < IPAP Max, the device may automatically provide additional pressure support with inspiratory pressures between IPAP Min and IPAP Max to normalize patient ventilation during sleep disordered breathing events (e.g. periodic breathing). Traditional SV Therapy.

4. When the BiPAP Auto SV controls are set for EPAP < IPAP Min = IPAP Max, the device is equivalent to traditional Bi-level therapy.

5. When the BiPAP Auto SV controls are set for EPAP < IPAP Min = IPAP Max with a set breath rate (BPM), the device is equivalent to traditional ST therapy.

Banned

Banned · Post by **Banned** » Thu Aug 07, 2008 9:50 pm

brazilian wrote: Dr. Vergara asked me today is to be his interlocutor with all you experts, in order to allow him to fully understand this BiPap "way of thinking".

thanks....

It's perhaps an assumption that Laryssa's therapy is in ST mode (per Item 5, above). However, the most recent data provided would lead one to believe the BiPAP Auto SV is (still) in SV mode (per Item 3, above).

I'm not an expert but does anyone care to comment on a BPM of 25 breaths per minute? I don't think my rabbit breathes that fast.

I know the medical team is titrating Laryssa to her O2 levels, but since her O2 is well above 95%, wouldn't it seem fit to lower her BPM just a little? Not that her AHI particularly concerns me, but wouldn't lowering her BPM also help her AHI?

Banned

ozij · Post by **ozij** » Thu Aug 07, 2008 9:55 pm

20-30 bmp is normal for preschool children.

O.

Banned · Post by **Banned** » Thu Aug 07, 2008 10:15 pm

ozij wrote:20-30 bmp is normal for preschool children.

Thanks O!

So if 3 would be the average Rise Time for an adult, what would be the average Rise Time for a preschool child?

Banned

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Little Larissa - please read

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