Here is a copy of Respironics AVAPS presentation from banned.
http://www.internetage.ws/cpapdata/manuals/avaps.pdf
DSM
On reading the manual it spells out pretty much what I thought (my summary) -
2 basic types of ventilation
- pressure
- volume
Hybrid is a combination of both - AVAPS is hybrid
Pressure ventilation (i.e. bilevel) has some limits
- can't guarantee a minimum volume
- shotgun approach
Volume ventilation used for special cases
- volume ventilation is driven by adjusting the pressure to meet the volume
When setting volume ventilation with the AVAPS IpapMax is typicaly set between 25-30 CMs (this is one area where I commented that if the person setting the machine doesn't understand that it is pressure that is needed to drive the volume, they may well set this too low)
Setting IT:
For Snoredog, look at the section in this doc on setting IT (INSP TIME) this may help clarify and support many of the issues you have raised in Bev's thread re setting IT. It says to set I time shorter for obstructive patients (allow more E time) and longer IT for restrictive patients (I to E 50%). So this is saying that obstructive patients need their Insp to exhale ratio to be biased shorter towards inhale (shorter time for breathing in than breathing out).
AGAIN it highlights that obstructive patients need shorter rise times (1-4) while restrictive patients need longer rise times (3-6) ! - what does that mean for Bev ? Did Bev get classified as an obstructive patient ? (I don't think she is restrictive).
The report has a test at the end where you are asked how to respond to several scenarios - good test
DSM
Newbie on AVAPS
Re: Newbie on AVAPS
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
If anyone wants a really good laugh, go read the 3 scenarios at the end of the AVAPS document - look at what the authors put up for the action answers. These people clearly have a good sense of humor allowing who the presentation is intended for.
But some cpaptalk members might argue that the extreme responses are very familiar to them & obviously this presentation is where the RTs/Staff learned them
DSM
But some cpaptalk members might argue that the extreme responses are very familiar to them & obviously this presentation is where the RTs/Staff learned them
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
OMG, ChECK ThIS OuT,. It shouldn't be this easy!
I had a feeling I was having a good night. Really Easy breathing, Turbinates clear in both nostrils, even when I turned from side-to-side, No disturbing IPAP/EPAP Switch, Silky smooth Ventilation, and pinned the Tidal Volume exactly where I wanted it!
My 11-2-08 settings were:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 200 ml
BPM: 6
Inspiration Time: 3 Sec
Rise time: 6
My Encore results:
Apnea Count: 0
Average EPAP: 14
Average IPAP: 18
Average (Exhaled) Tidal Volume: 535 ml
Average Breath Rate: 16.2
Average % Patient Triggered Breaths: 100%
Average Leak: 43.4
Average Peak Inspiratory Flow: 37
Average Minute Ventilation: 8.6
The Adapt SV always had my Tidal Volume around 500 ml, often less. AVAPS in S/T (only) mode had me between 512 ml and 523 ml.
In light of no core ventilation issues, S/T AVAPS Mode, using only 200 ml of Tidal Volume still offers an incremental and guaranteed VT boost!
Since AVAPS, no gasping (PB) episodes.
Good Bye, SV!
Banned
I had a feeling I was having a good night. Really Easy breathing, Turbinates clear in both nostrils, even when I turned from side-to-side, No disturbing IPAP/EPAP Switch, Silky smooth Ventilation, and pinned the Tidal Volume exactly where I wanted it!
My 11-2-08 settings were:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 200 ml
BPM: 6
Inspiration Time: 3 Sec
Rise time: 6
My Encore results:
Apnea Count: 0
Average EPAP: 14
Average IPAP: 18
Average (Exhaled) Tidal Volume: 535 ml
Average Breath Rate: 16.2
Average % Patient Triggered Breaths: 100%
Average Leak: 43.4
Average Peak Inspiratory Flow: 37
Average Minute Ventilation: 8.6
The Adapt SV always had my Tidal Volume around 500 ml, often less. AVAPS in S/T (only) mode had me between 512 ml and 523 ml.
In light of no core ventilation issues, S/T AVAPS Mode, using only 200 ml of Tidal Volume still offers an incremental and guaranteed VT boost!
Since AVAPS, no gasping (PB) episodes.
Good Bye, SV!
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
Re: Newbie on AVAPS
SV should be able to run that mode, the following settings you used are fixed BPM settings:Banned wrote:OMG, ChECK ThIS OuT,. It shouldn't be this easy!
I had a feeling I was having a good night. Really Easy breathing, Turbinates clear in both nostrils, even when I turned from side-to-side, No disturbing IPAP/EPAP Switch, Silky smooth Ventilation, and pinned the Tidal Volume exactly where I wanted it!
My 11-2-08 settings were:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 200 ml
BPM: 6
Inspiration Time: 3 Sec
Rise time: 6
My Encore results:
Apnea Count: 0
Average EPAP: 14
Average IPAP: 18
Average (Exhaled) Tidal Volume: 535 ml
Average Breath Rate: 16.2
Average % Patient Triggered Breaths: 100%
Average Leak: 43.4
Average Peak Inspiratory Flow: 37
Average Minute Ventilation: 8.6
The Adapt SV always had my Tidal Volume around 500 ml, often less. AVAPS in S/T (only) mode had me between 512 ml and 523 ml.
In light of no core ventilation issues, S/T AVAPS Mode, using only 200 ml of Tidal Volume still offers an incremental and guaranteed VT boost!
Since AVAPS, no gasping (PB) episodes.
Good Bye, SV!
Banned
BPM: 6
Inspiration Time: 3 Sec
Rise time: 6
Inspiration Time on the SV will never exceed 3 seconds (probably same on AVAPS). If I:E ratio is maintained, that is a 6 second breath, the math putting that in a minute is 10 which is a BPM=10. You can have a shorter IT time just not longer. By putting PBM=6 that is a 10 second breath, since it can never exceed 3 seconds inspiration time, and you are using a 6 second rise time we lost 1 second there somewhere, ah but the machine says your ventilation rate is 8.6 seconds, that is about as close to 9 seconds as you can get. I haven't read the AVAPS manual yet but my guess is BPM=8 would have worked just as well.
These are the type of settings I think Bev needs on her SV. A lot of the result is obtained by the BPM settings.
Glad your results were positive.
someday science will catch up to what I'm saying...
Re: Newbie on AVAPS
Banned,
Very good - best I can get on my Bipap SV is HI=0 & AI=0.4 (actually 3 AI events for the whole night.)
So your search is paying dividends.
DSM
Very good - best I can get on my Bipap SV is HI=0 & AI=0.4 (actually 3 AI events for the whole night.)
So your search is paying dividends.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
Banned,
Congratulations on your progress! Painstaking tweaking and testing does pay off!
Cheers,
Sleepy55
Congratulations on your progress! Painstaking tweaking and testing does pay off!
Cheers,
Sleepy55
_________________
| Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear |
| Additional Comments: 22 IPAP/ 20 EPAP / Bi-Flex Mode (No Backup Rate) / Mindray PM-60 Pulse Oximeter |
Re: Newbie on AVAPS
Here's a thought,
Although AVAPS is designed for people with core ventilatory distress, AVAPS is also suitable for all non-acute ventilatory challenges involving Bi-level therapy where a higher Tidal Volume is preferred.
During my AVAPS trials it was very clear there are two quite different and distinct methods to achieve the same Tidal Volume.
Each method may target a distinctly different patient groups.
To simplify, divide these two patient groups into 1) Acute, and 2) Non-Acute.
1) Acute AVAPS Tidal Volume therapy - Includes patients with COPD, Neuromuscular Disease, Amyotrophic Lateral Sclerosis, Obesity, Chest Wall Deformity, etc..
Example: Assume patient/AVAPS titration settings: EPAP 13cm, IPAP Min 17cm, IPAP max 25cm, 600 ml VT required.
Method to achieve Tidal Volume of 600 ml - Dial in the prescribed 600 ml Tidal Volume in AVAPS.
Result 1 - The practitioner dials in the full required Tidal Volume regardless the patient's current Tidal Volume.
Result 2 - Min PS spikes and sustains in excess of 20cm to provide pressure support needed to maintain a 600 ml VT flow.
Result 3 - Apnea Count is uncontrollable because of the sustained IPAP Min 20cm supporting 600 ml VT.
Result 4 - The practitioner does not care about Apnea Count because the intent is to adequately ventilate the acute patient with the proper Tidal Volume.
2) Non-Acute Tidal Volume Therapy - Includes patients with no core respiratory anomalies but require Bi-level support and prefer additional Tidal Volume (e.g.
Additional Tidal Volume to address inherently low VT and/or the deleterious effect of traditional CPAP/Bi-level pressure therapies that further reduces Tidal
Volume).
Example: Assume patient/AVAPS titration settings: EPAP 13cm, IPAP Min 17cm, IPAP max 25cm, 600 ml VT preferred.
Method to achieve Tidal Volume of 600 ml - Dial in (Minimum) 200 ml Tidal Volume in AVAPS.
Result 1 - The practitioner dials in the lowest possible AVAPS VT setting (200 ml) to supplement the patient's existing Tidal Volume
Result 1 - Min PS will settle at IPAP Min.
Result 2 - Apnea Count is controllable because you have not exceeded IPAP Min.
Result 3 - Apnea Count is controlled and the existing Tidal Volume is given a incremental and sustained boost.
Result 4 - The practitioner can incrementally raise the 200 ml Tidal Volume to raise over-all Tidal Volume while keeping an careful eye on Apnea Count.
Having personally tried both scenarios, the above two cases (though using different numbers) are accurate as I experienced them.
Banned
Although AVAPS is designed for people with core ventilatory distress, AVAPS is also suitable for all non-acute ventilatory challenges involving Bi-level therapy where a higher Tidal Volume is preferred.
During my AVAPS trials it was very clear there are two quite different and distinct methods to achieve the same Tidal Volume.
Each method may target a distinctly different patient groups.
To simplify, divide these two patient groups into 1) Acute, and 2) Non-Acute.
1) Acute AVAPS Tidal Volume therapy - Includes patients with COPD, Neuromuscular Disease, Amyotrophic Lateral Sclerosis, Obesity, Chest Wall Deformity, etc..
Example: Assume patient/AVAPS titration settings: EPAP 13cm, IPAP Min 17cm, IPAP max 25cm, 600 ml VT required.
Method to achieve Tidal Volume of 600 ml - Dial in the prescribed 600 ml Tidal Volume in AVAPS.
Result 1 - The practitioner dials in the full required Tidal Volume regardless the patient's current Tidal Volume.
Result 2 - Min PS spikes and sustains in excess of 20cm to provide pressure support needed to maintain a 600 ml VT flow.
Result 3 - Apnea Count is uncontrollable because of the sustained IPAP Min 20cm supporting 600 ml VT.
Result 4 - The practitioner does not care about Apnea Count because the intent is to adequately ventilate the acute patient with the proper Tidal Volume.
2) Non-Acute Tidal Volume Therapy - Includes patients with no core respiratory anomalies but require Bi-level support and prefer additional Tidal Volume (e.g.
Additional Tidal Volume to address inherently low VT and/or the deleterious effect of traditional CPAP/Bi-level pressure therapies that further reduces Tidal
Volume).
Example: Assume patient/AVAPS titration settings: EPAP 13cm, IPAP Min 17cm, IPAP max 25cm, 600 ml VT preferred.
Method to achieve Tidal Volume of 600 ml - Dial in (Minimum) 200 ml Tidal Volume in AVAPS.
Result 1 - The practitioner dials in the lowest possible AVAPS VT setting (200 ml) to supplement the patient's existing Tidal Volume
Result 1 - Min PS will settle at IPAP Min.
Result 2 - Apnea Count is controllable because you have not exceeded IPAP Min.
Result 3 - Apnea Count is controlled and the existing Tidal Volume is given a incremental and sustained boost.
Result 4 - The practitioner can incrementally raise the 200 ml Tidal Volume to raise over-all Tidal Volume while keeping an careful eye on Apnea Count.
Having personally tried both scenarios, the above two cases (though using different numbers) are accurate as I experienced them.
Banned
Last edited by Banned on Tue Nov 04, 2008 8:39 am, edited 1 time in total.
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
Re: Newbie on AVAPS
Banned,
Those scenarios make sense to me & is very interesting info. Thanks for sending me that presentation it of itself had a lot of interesting info in it.
DSM
Those scenarios make sense to me & is very interesting info. Thanks for sending me that presentation it of itself had a lot of interesting info in it.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
Ok, a little less good Apnea Count last night.
11-3-08 settings:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 200 ml
Encore results:
Apnea Count: 8
Average EPAP: 14
Average IPAP: 18
Average (Exhaled) Tidal Volume: 536 ml
Banned
11-3-08 settings:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 200 ml
Encore results:
Apnea Count: 8
Average EPAP: 14
Average IPAP: 18
Average (Exhaled) Tidal Volume: 536 ml
Tonight, I'll test those scenarios by dialing in a straight 530 ml Tidal Volume (rather than the alternative 200 ml that I have been using). There should be a difference in PS at IPAP Min to support the VT. Change in Apnea Count to be determined.dsm wrote: Those scenarios make sense to me & is very interesting info. Thanks for sending me that presentation it of itself had a lot of interesting info in it.
Banned
Last edited by Banned on Tue Nov 04, 2008 11:56 pm, edited 1 time in total.
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
Re: Newbie on AVAPS
Good luck with tonight's tests - but will the coming change of leadership (expecting a concession speech any moment here) disturb your sleep
Could do mine - no matter which way it went
DSM
Could do mine - no matter which way it went
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
This will be the best nights sleep we Americans will have gotten in the last 8 miserable years!dsm wrote:Good luck with tonight's tests - but will the coming change of leadership (expecting a concession speech any moment here) disturb your sleep
Could do mine - no matter which way it went
DSM
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
Re: Newbie on AVAPS
Double post
Last edited by Banned on Thu Nov 06, 2008 8:41 am, edited 2 times in total.
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
-
Guest
Re: Newbie on AVAPS
Banned wrote:Weird waking up this morning. The morning had a whole different feel about it. Exhilarating, like it's great to be alive feeling. Allot of people at work including my clients said they experienced the same thing.
Don't know how well my AVAPS theories hold up, but here are the facts:
11-4-08 settings:
Mode: S/T AVAPS
EPAP: 14
IPAP Min: 18
IPAP Max: 25
Tidal Volume: 530 ml
Encore results:
Apnea Count: 7
Average EPAP: 14
Average IPAP: 18.4
Average (Exhaled) Tidal Volume: 557 ml
Average Breath Rate: 16.2
Average % Patient Triggered Breaths: 100%
Average Leak: 43.4
Average Peak Inspiratory Flow: 37
Average Minute Ventilation: 8.6
Generally speaking, when setting the total desired tidal Volume, the resulting Average (Exhaled) Tidal Volume will be 20ml above the set tidal Volume. That probably doesn't mean much since Average (Exhaled) Tidal Volume is less of a machine average and more of a machine guess.
The key with using AVAPS in a Non-Acute setting is not to exceed more than 10% of the Tidal Volume in S/T (only) mode, and ignore the 8 ml AVAPS target.
The 10% extra Tidal Volume keeps me much more alert during the day and is well worth the 7-8 AHi.
My next trial to try and reduce the 7-8 AHi might be:
Mode: S/T AVAPS
EPAP: 15
IPAP Min: 19
IPAP Max: 25
Tidal Volume: 530 ml
We'll see.
Banned
Hey dsm, nice avatar. Glad you are FINALLY using the Quattro!
Re: Newbie on AVAPS
Banned,
Good to see you are honing in on that AHI with AVAPS.
RE the avatar - was taken last month on visit to NZ - thought I should stick something up - it is some years since I last had one showing
DSM
Good to see you are honing in on that AHI with AVAPS.
RE the avatar - was taken last month on visit to NZ - thought I should stick something up - it is some years since I last had one showing
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Re: Newbie on AVAPS
Oh, <5 AHi at EPAP 15cm and IPAP Min 19..
11-5-08 settings:
Mode: S/T AVAPS
EPAP: 15
IPAP Min: 19
IPAP Max: 25
Tidal Volume: 530 ml
Encore results:
Apnea Count: 4
Average EPAP: 15
Average IPAP: 19.3
Average (Exhaled) Tidal Volume: 558.2 ml
Average Breath Rate: 16
Average % Patient Triggered Breaths: 99.9%
Average Leak: 45.2
Average Peak Inspiratory Flow: 37,7
Average Minute Ventilation: 8.9
I'll sleep another night or two at these settings and see if <5AHi is sustainable.
Otherwise, there is always EPAP 16 and IPAP Min 20 to chase <1AHi.
Here's what I know. AVAPS is as comfortable as the Adapt SV (although at higher pressures) but provides a guaranteed Tidal Volume of of 60 ml more than the Average Vt from the SV. I'm still within the AVAPs recommended Vt to 110% of actual Vt in S/T (only) mode. In S/T (only) mode, Vt was between 513 & 523 ml.
"So, how are you feeling?"
I'm feeling very rested, thank you, and I attribute it to the extra Vt that is keeping me more alert and less tired.
Banned
11-5-08 settings:
Mode: S/T AVAPS
EPAP: 15
IPAP Min: 19
IPAP Max: 25
Tidal Volume: 530 ml
Encore results:
Apnea Count: 4
Average EPAP: 15
Average IPAP: 19.3
Average (Exhaled) Tidal Volume: 558.2 ml
Average Breath Rate: 16
Average % Patient Triggered Breaths: 99.9%
Average Leak: 45.2
Average Peak Inspiratory Flow: 37,7
Average Minute Ventilation: 8.9
I'll sleep another night or two at these settings and see if <5AHi is sustainable.
Otherwise, there is always EPAP 16 and IPAP Min 20 to chase <1AHi.
Here's what I know. AVAPS is as comfortable as the Adapt SV (although at higher pressures) but provides a guaranteed Tidal Volume of of 60 ml more than the Average Vt from the SV. I'm still within the AVAPs recommended Vt to 110% of actual Vt in S/T (only) mode. In S/T (only) mode, Vt was between 513 & 523 ml.
"So, how are you feeling?"
I'm feeling very rested, thank you, and I attribute it to the extra Vt that is keeping me more alert and less tired.
Banned
AVAPS: PC AVAPS, EPAP 15, IPAP Min 19, IPAP Max 25, Vt 520ml, BPM 10, Ti 1.8sec, RT 2 (Garage)
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro
BiPAP Auto SV: EPAP 9, IPAP Min 14, IPAP Max 25, BPM 10, Ti 2sec, RT 2 (Travel Machine)
VPAP Adapt SV: EEP 10.4, Min PS 4.4 (Every Day)
Mask: Quattro