ResMed S8 Vantage EPR

Excellent graph at the link you posted, Dave. As were your comments... there, and here.

dsm, you wrote:

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'm glad you said "for me". Certainly there are some for whom C-Flex works against their getting good treatment. Or comfortable treatment.

My opinion, however, is that C-Flex already is a great therapeutic comfort benefit to many people, and that EPR is likely to be so, too.

I may be very wrong, but I think most people who try C-Flex receive more benefits than downside effects when using it. I believe it can make the deciding difference for many people to be able to "do" this kind of treatment at all -- instead of dropping out. I really don't think it is of "more value" as a marketing tool for Respironics.

The jury is still out on how ResMed's EPR will suit people, comfort-wise. And, as Dave points out...how EPR will handle them treatment-wise. I hope EPR proves to be at least as beneficial, or even more so, as C-Flex is for many.

RG,

Fair comment.

I will still for the moment hold to the view that CFLEX EPR etc are excellent aids at getting started with xPAP but I really do believe their value drops away within weeks once a new xPAP patient has got past the chest pains etc:.

The issue I believe I see repeatedly in the forums is people with cflex identifying problems they wouldn't be having if they turned it off & it does seem to me that those problems are every bit as likely to put them off xPAP should they not understand where they originate from and they persist.

This is an interesting area of discussion.

Cheers

DSM

deltadave wrote:
<snip>
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.

<snip>

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

Dave,

In further thinking about your analysis (& having read the linked to post in much greater detail), I could see in the above situation (your post) that if this EPR introduced a fixed but fractional lag when it detects the similar part of the expiration cycle that CFLEX does, before reversing the pressure, then it could achieve the same effect without the questionable pressure bump that we can experience. It seems that until we get either a detailed technical explanation or a machine to test then there is a lot of supposition.

I am not yet swayed from my belief that this type of xPAP mechanism is a great starting aid but can introduce as many complications as it solves.

Cheers

Doug

it does seem to me that those problems are every bit as likely to put them off xPAP should they not understand where they originate from and they persist.

This is an interesting area of discussion.

Fair comment, too, dsm. And yes, it's a very interesting area of discussion!

I am not yet swayed from my belief that this type of xPAP mechanism is a great starting aid but can introduce as many complications as it solves.

Nor am I from my belief that it provides continuous benefit without introducing as many complications as it solves. I've noticed at least as many, or more, posts saying someone LOVES C-Flex, as I've seen from people for whom it was counterproductive.

Good thing it's optional and can be turned off.

those problems are every bit as likely to put them off xPAP should they not understand where they originate from and they persist.

Good point, dsm.

Not understanding what is causing a problem is a problem...for sure!

Good thing there are message boards with a wide variety of pro/con posts on everything from machines and masks to finer points like..."to C-Flex or not to C-Flex."

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

Panting. Breathing rapidly with none of the breaths being 'full' and satisfying. Breathing increases in speed and less carbon dioxide is blown off with each breath. User is trying to play 'catch-up' with the machine but cannot as the machine ALWAYS (by design) begins the pressure increase before the user has fully finished exhaling. Also, if the user has any pause between exhalation and beginning the next inhalation, C-FLEX is intolerant of this.

I think that if C-FLEX were able to wait for the user to start his/her inhalation before it kicked up the pressure, it would be great! Then, however, I think we would be calling it bi-level.

https://www.cpap.com/productpage/resmed ... p-h3i.html

The above link shows the new 'Vantage' - the price is interesting.

There are multiple photos from all angles.

The h/h looks quite big and appears to treble the length of the unit (I have one on the way for my S8 Escape).

The linked to page doesn't say much about EPR but the summary on cpap.com mentions it.

Cheers

DSM

Reading about the new Humidaire 3i for ResMed's S8 machines:

ResMed's Humidaire 3i heated humidifier

The product features mentions this:

* Fliptop lid design - no need to remove tube to refill water chamber. Convenient and user-friendly.

That caught my attention, as the previous ResMed humidifiers (Humidaire and Humidaire 2i) could not be filled from the top. Most aggravating as I like to just add more distilled water as needed.

Sounds like ResMed has made it easier for "top fillers" to easily add water.

Johnny, in the neat thumbnail pics with the product, would it be possible for you to add two more pictures of the humidifier from the side and from above -- with lid open?

ResMed sure got it right keeping the nice big dial on top for heat adjustment. Very handy!

Johnny,

Just wanted to add to RG's comments - the photos there are great, I just realised that they can all be enlarged - vey good work.

That top filling issue is a great step forward for ResMed (filling the 2i is a PITB).

Photos of it with lid open would be a good addition.

Cheers

DSM

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Met the with ResMed representative today, and he brought along an S8 Elite with EPR, their response to the Respironics CFlex. Only had time to generate a single wave analysis, but overall this seems like an excellent modality, I was thoroughly impressed.
If you want to see the graph:

ResMed EPR

There's still a couple of questions I have, they're points that have already been covered in this discussion, but even if they prove to be true they may be easily surmountable.

They are maintaining EPR virtually up to the point of inhalation, we're kinda skirting bilevel.

The performance of this unit at high pressures, though, was outstanding, they have absolutely solved the bump issue (by running the EPR to the point of inhalation).
I'm trying to get a diagnostic unit, and be able to post more detailed wave analysis, but just as a how does it feel unit, it really was excellent.
deltadave

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deltadave wrote:Met the with ResMed representative today, and he brought along an S8 Elite with EPR,

Dave,

Many thanks for the 1st real feedback any of us has on these units. I didn't even know they had a thing called EPR until this thread was started by WillSucceed.

What it tells me is that xPAP machines are advancing rapidly and that a modern AUTO can basically do it all (perhaps with some minor tweaks, even displace BiLevel devices).

For me it has been a great feeling knowing I can switch between modes. When I was about to start on CPAP I had no idea this was possible until the good folks here said so else I would have bought an F&P machine with integrated h/h.

Thanks too for the graphs - very useful in understanding what is actually happening.

One concern I have about the growing sophistication of these devices is the ability of the medical fraternity to be comfortable about recommending particular brands let alone understanding what the differences are between them.

CPAP was pretty easy to recommend as there are only minor differences - mostly just the h/h units and issues like size weight & noise.

AUTOs are a whole new world with subtilties that few people can expect to grasp. But as long as there is cpaptalk.com (& other similar sites) I guess it is up to the patient to invest some time & effort to learn but I suspect most won't and more because they have too many other lines of interest they are following.

Cheers

DSM

dsm wrote: What it tells me is that xPAP machines are advancing rapidly and that a modern AUTO can basically do it all (perhaps with some minor tweaks, even displace BiLevel devices).

Actually a lot of the technology they are adding to CPAPs comes from BiPAPs so it not all new technology. I do think there will come a day were BiPAPs will probably not be needed for patients with straight forward OSA with no other breathing problems. A lot of the time it seems the only reason to put someone with straight OSA on BiPAP comes down to 'comfort'...needing relief on exhale or for relatively high pressure...and by borrowing technology from BiPAPs, CPAPs will be able to help in those situations.

I don't think CPAPs will ever be able to replace BiPAPs completely- BiPAPs are used for a lot of other breathing problems like COPD, post polio, weaning from full venilator, CSA, ALS, chronic respiratory failure, etc that need the noninvasive positive pressure ventilation. CPAP, by its difinition, cannot provide that type of support. The more complex BiPAPs can monitor a lot more about a persons breathing then a CPAP can- my Encore Pro reports for my Synchrony gives me results on Minute Ventilation, Tidal Volume, Peak Flow, and other respiratory measures that can be useful with more complex breathing problems. In addition to more complex computer functioning, some high end BiPAPs also have a lot larger memory- my Synchrony can hold 6 months worth of full nightly data, not just compliance.

dsm wrote

What it tells me is that xPAP machines are advancing rapidly and that a modern AUTO can basically do it all

If the EPR feature were available (which it's not) in autopap mode in ResMed's new S8 Auto, I'd agree -- except, of course, for the special cases that christinequilts points out where a true bi-level machine is needed.

I agree absolutely with what you said here, dsm:

One concern I have about the growing sophistication of these devices is the ability of the medical fraternity to be comfortable about recommending particular brands let alone understanding what the differences are between them.

Thanks sooo much, Dave, for the early lab-ratting you're doing, looking at ResMed's EPR feature!! And especially your efforts to find out when/how it triggers on/off. Intriguing stuff!

YAY........

My S8 vantage will be here tommorrow. I just got my tracking info by e-mail......

I guess ResMed did get them out on the release date.

I will let everyone know what my thoughts are on the machine after I use it!

My S8 vantage will be here tommorrow. I just got my tracking info by e-mail......

Dirk: I think that many of us are very much looking forward to your review. Please keep us posted! Hope the machine works well for you!