ResMed S8 Vantage EPR

EPR is in the S8 Vantage and S8 Elite. It is in no other machines.

cpapseller wrote:EPR is in the S8 Vantage and S8 Elite. It is in no other machines.

Thanks - this makes sense.

Another question I have is in regard to the upgrading of models - I see on our Aust ResMed site that the middle model (your ref = S8 Elite) can be upgraded to the AUTO model (the S8 Spirit).

Do you know the price for this ?

In Australia the low end model is called the Lightweight - do you know how it relates to the S8 Escape model ? - is the Escape actually the Elite or the Lightweight ?

Thanks

DSM

Thanks for the clear answers to my questions, cpapseller. I especially appreciated your contacting ResMed to get a direct answer about whether or not EPR would be availabe when the new machine was operating in auto mode.

Resmed says no, the machine must be in the cpap mode for the EPR to function.

I'm really, really disappointed to hear that.

dsm I may be wrong, but I *think* cpapseller meant to type "Escape" instead of "Elite". "Escape" being the name of ResMed's new straight cpap machine with EPR.

rested gal wrote:
dsm I may be wrong, but I *think* cpapseller meant to type "Escape" instead of "Elite". "Escape" being the name of ResMed's new straight cpap machine with EPR.

RG,

I just pulled out my lil ole Escape & checked the menus once again. There is no place in either clinical or patient mode that looks anything like EPR or EPR adjustments. It was this that made me wonder in the first place if the Escape was a 'lightweight' or in fact a pre-market machine that will now disappear.

It is confusing at the moment with so many of these names & features appearing & disappearing - I am still intrigued as to how WillSucceed knew about EPR when it wasn't listed on any ResMed site nor any other that I could find (although the now dissapeared name 'Vantage' did appear on cpap.com for a very short period)

your own expectations are pretty finely honed

DSM

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I am still intrigued as to how WillSucceed knew about EPR when it wasn't listed on any ResMed site nor any other that I could find

What can I say? Long tentacles? Connections? Prescience?

Take your pick!

S8 Escape does not have EPR. Only the S8 Elite and S8 Vantage do. There will be a fourth S8model released in the USA in October. It will be a basic model on the S8 platform.

So (if you don't mind me jumping in here) with the ResMed machines you're discussing with EPR, the good news is:
1.... there is a definite 1cm drop per setting change (unlike Respironics' C-Flex inexplicit drop), AND
2.....it operates more like a bipap (IPAP/EPAP) than the exhalation relief of C-Flex.

BUT the bad news is:
the EPR feature is disabled when the machine is used in auto mode.

Is that correct?

What a shame. So close, and yet so far....

LOL!! I guess I'll just sit back and watch for a year or so to see what names the S8 machines finally go by...and in which countries.

Funny thing is that the early names being tossed onto the message boards back when the S8's were first being talked about, and while they were still just a gleam in ResMed's eye were:

S8 Prime and S8 Pioneer.

Those names (if they ever were more than just "rumor" names) were obviously discarded in favor of....
whatever they are now.

cpapseller wrote:Does EPR maintain the expiratory pressure even after the exhalation is completely finished?

Yes, it goes back to the cpap setting or auto adjusted setting upon the initialization of the inhalation.

Then this means it's not "like" BiPAP, it IS BiPAP. I see two concerns here.

The first is that if the EPR is set below the critical presssure for apneas, it will not trigger at all because it won't be able to sense inspiration.
The second concerns getting the physicians to prescribe this therapy. Will they have to order BiPAP? I don't think just saying EPR will cut it, because now, the implication is that EPR refers to application of therapy only on active expiration. If it's applied throughout the expiratory phase, yes, you have to say EPAP, and that makes it BiPAP. There may need to be some substantial physician education early on in this therapy.
I'm certainly looking forward to Monday as well.
deltadave

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, auto

Please let me make one clarification of a previous statement I made. EPR is a feature in the S8 Vantage but functions ONLY when the machine is in a fixed pressure cpap mode. EPR will not function when a Vantage is in Auto mode.

The S8 Elite and S8 Vantage with EPR were approved by the FDA as cpap (HCPCS code EO601), not a (bilevel) "respiratory assist device without a backup rate" (HCPCS code E0470). Is the line between cpap and a bilevel getting blurry?

Bilevel is a loose industry term for respiratory assist device. BiPAP is a registered trademark of Respironics and refers specifically to certain of their products. The term "RAD" is also used for respiratory assist device.

Anyone that wants to dive deeper what a RAD is can go to http://www.palmettogba.com/palmetto/Pro ... enDocument

deltadave wrote:

cpapseller wrote:Does EPR maintain the expiratory pressure even after the exhalation is completely finished?

Yes, it goes back to the cpap setting or auto adjusted setting upon the initialization of the inhalation.

Then this means it's not "like" BiPAP, it IS BiPAP. I see two concerns here.

The first is that if the EPR is set below the critical presssure for apneas, it will not trigger at all because it won't be able to sense inspiration.
The second concerns getting the physicians to prescribe this therapy. Will they have to order BiPAP? I don't think just saying EPR will cut it, because now, the implication is that EPR refers to application of therapy only on active expiration. If it's applied throughout the expiratory phase, yes, you have to say EPAP, and that makes it BiPAP. There may need to be some substantial physician education early on in this therapy.
I'm certainly looking forward to Monday as well.
deltadave

cpapseller wrote:Bilevel is a loose industry term for respiratory assist device. BiPAP is a registered trademark of Respironics and refers specifically to certain of their products.

DSM wrote:Deltadave,

Don't get too worked up with your comments until you are really sure you understand EPR. (well not on a public forum anyway )

Cheers


DSM

Hi DSM:
As far as the operation of EPR in Resmed devices, you're right, never tried it, never even seen it, only trying to comment on some of the speculations on how it might work.
I have been fiddling around with CFlex however, please refer to my post elsewhere regarding it's characteristics:

Characteristics of CFlex

My point still remains that if EPR is carried throughout the expiratory cycle to the point of inspiration, then the only possible trigger could be negative inspiratory pressure at a now-subtherapeutic level. This would mean that the only time the patient would see his prescribed pressure would be during the inspiratory phase. A whole new EPAP has been established, and call it BiPAP, Bilevel, or whatever, but by definition, it's not CPAP. And if you aren't at therapeutic CPAP level prior to inspiration, some people are going to have an issue with that.
For example, let's say your CPAP is set at 15 cmH2O. You put your EPR at 3 cmH2O. If negative insiratory pressure is the trigger for resumption of CPAP level, that's another 1-2 cmH2O anyway, so at the critical point where the OSA occurs, you're only at 10-11 cmH2O.
The second possibility would be that the termination of of EPR is triggered by the expiratory flow, which would make it similar to CFlex, whose explanation you have accurately made elsewhere in the forum.
The third possibility is that Resmed has a more novel approach to EPR, where they are able to run it up close, but not to, the point of inspiration.
At any rate, I certainly intend to run a side-by-side waveform comparison as soon as I can get my hands on a Resmed EPR, and if they can address at least one of those 2 issues, prevention of decay of the expiratory limb during high pressure therapy, or carrying the EPR deep into the static phase yet maintaining therapeutic CPAP at the point of inspiration, you can bet we'll be putting all of our patients on this new therapy.
deltadave

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To DeltaDave,

I guess the angle I am coming from is that CFLEX & EPR are cpap aids. I believe that many folk are led to believe they are more important features than they really are.

They do appear to be great to help some people get started on CPAP, esp those on higher recommended cms and particularly those folk who do not suffer from mouth leak problems with nasal masks.

But the side effects of CFLEX in particular appear to outweigh the benefits in some cases & I put my case in that category. I specifically ordered a machine with CFLEX, I used it for the 1st 6 weeks then after several experiments & lots of reading of other peoples problems it dawned on me where many of my & their problems were coming from. When I stopped using CFLEX most of them went away. I believe the same has happened for a few others who stopped using CFLEX.

The problems in question are ...

- Mouth pops (bursts of air escaping from the mouth)
- Aerophagia
- Excessive noise from the xPAP (motor winding up & down) disturbing partners

So in balance, for me, CFLEX & EPR are minor extras provided by vendors, that are capable of introducing as many problems as they solve & thus not anything to get to excited about. I suspect that they are more of value as marketing tools to the respective vendors.

*************

I see from your posts that you have no equipment listed.
Are you on xPAP yourself ? - what gear do you use ? - do you use CFLEX ?

Cheers

DSM

- Mouth pops (bursts of air escaping from the mouth)
- Aerophagia
- Excessive noise from the xPAP (motor winding up & down) disturbing partners

You left out breath-stacking, which occurs when C-FLEX kicks in BEFORE the user is finished exhaling. Very unpleasant.

So in balance, for me, CFLEX & EPR are minor extras provided by vendors, that are capable of introducing as many problems as they solve & thus not anything to get to excited about. I suspect that they are more of value as marketing tools to the respective vendors.

I don't know much about EPR yet, and although there are those who swear by C-FLEX, I very much agree with this statement. Huge marketing ploy that has been, I suspect, very successful for Respironics. Now that ResMed is getting readyto flogg their EPR, ya gotta wonder if/when Puritan-Bennett will develop their own exhalation relief system.

WillSucceed wrote:

<snip>
You left out breath-stacking, which occurs when C-FLEX kicks in BEFORE the user is finished exhaling. Very unpleasant.
<snip>

WillSucceed,
THat was another problem but I couldn't think of a simple way to describe it. From recollection it was noticable on CFLEX of 2 & 3 but not as bad on 1.

My wife used to say to me "are you trying to manipulate the machine" but all I recall doing was coping with that reversing of pressure at the end of the exhalation cycle. I used to find it forced me to do a swallowing action, this used to cause my ears to pop mildly. This effect was intolerable on CFLEX of 3 and with my machine at high cms.

If you were put 'breath stacking' another way, how would you describe it ?

Cheers - DSM