New machine - iVAPS

SleepWellCPAP wrote: Recently ResMed came out with a new machine that ventilates at the alveolar level

I'm thinking iVAPS marketing probably decided to mention alveolar-flow estimating & targeting, simply because IPAP increases without flow feedback doesn't always increase lung flow:

V F Parreira, et al wrote: Increases in inspiratory pressure did not always lead to increases in effective ventilation reaching the lungs. This was due to a significant narrowing of the glottis by adduction of the vocal cords in all subjects.

http://www.atsjournals.org/doi/abs/10.1 ... .5.8630611

Maybe my view of ASV vs AVAP (iVAP?) is simplistic, but I don't think assured tidal volume support is nearly as comprehensive as a breath by breath correcting methodology provided by ASV. Apples and oranges in my opinion. BTW, the newer ASV technologies do support tidal volume assurance. Also, I agree ASV or AVAP is generally overkill for most basic sleep disorder conditions, that is, for simple Obstructive Sleep Apnea situations where constant air pressure is fine for knocking out airway collapse.

Sir NoddinOff wrote: Also, I agree ASV or AVAP is generally overkill for most basic sleep disorder conditions, that is, for simple Obstructive Sleep Apnea situations where constant air pressure is fine for knocking out airway collapse.

Agreed. In general, PAP machines either stent upper-airway obstruction with static pressure or they ventilate with pressure support (IPAP minus EPAP). If one only has upper-airway occlusion, then there's no need to ventilate with pressure support according to consensus sleep medicine. Rather than ventilate, EPAP might be selected for expiratory comfort in purely obstructive patients.

Sir NoddinOff wrote: BTW, the newer ASV technologies do support tidal volume assurance.

I must respectfully disagree with that statement. The newest ASV machines still do not support what the manufacturers refer to as "volume assurance". Instead, both new and old ASV machines target a sliding window of recent-averaged patient flow. And targeting patient flow with a variable recent-average is VERY different than using a constant "volume assurance" flow target. Those variable and hence unassured ASV flow targets compose the risk for hypoventilatory patients: a gradually-decreasing recent average of patient flow can actually allow ASV algorithms to target hypoventilation as acceptable flow rates. Again that short-sighted, variable flow targeting is THE inherent risk of using volume-unassured ASV with hypoventilatory patients.

By contrast, "volume assurance" works with a minimum or assured flow-volume---explicitly set by the clinician---below which the machine is not allowed to target, under any circumstances. That last clinician-set parameter is one feature that distinguishes a volume assurance machine from ASV. What really distinguishes the new ASV technologies from previous ASV is the ability for the machine to vary EPAP and min IPAP to automatically address an obstructive SDB component. The earlier ASV machines required that the obstructive SDB component be manually addressed with a fixed EPAP and min IPAP pair.

-SWS wrote:... I'm surprised you think iVAPS information is irrelevant to this board. We have patients on this message board with respiratory insufficiency disorders such as NMD, COPD, obesity hypoventilation. Some are already using AVAPS. They now have an alternative to the algorithmic nuances of AVAPS---namely iVAPS. And overlap apnea patients with COPD, such as Slinky, might find iVAPS/AVAPS discussions with their doctors potentially fruitful as their condition progresses.

Yup, yup, -SWS, I'm already planning on asking my pulmonologist about the iVPAP the next time I see him. I don't know if I would benefit or not but "no ask, no answer". And my S8 VPAP Auto was 5 years old this past March and still running like a charm.

I'm hoping we see more about this here as well. I know that these machines are overkill for most of the people here, but those of us with more complicated conditions like to keep informed about changes and advancements in therapy.

I don't know what the future holds and it could turn out that iVAPS is the direction I might go down the road. If anyone had told me four years ago that I would start using cpap equipment and eventually end up on the Trilogy, I'd have laughed until it hurt.

And look at me now....

You all keep talking about it, I promise I will be reading and following it...

Slinky wrote: I'm already planning on asking my pulmonologist about the iVPAP the next time I see him. I don't know if I would benefit or not but "no ask, no answer". And my S8 VPAP Auto was 5 years old this past March and still running like a charm.

Hey, Slinky! Good to hear from you. Resmed states that hypercapnic patients are the ones most likely to benefit from iVAPS. Anyone with advanced COPD is probably keeping periodic tabs on CO2 retention. If you discover that you're hypercapnic, then an iVAPS or AVAPS trial probably makes sense.

Madalot wrote:I'm hoping we see more about this here as well. I know that these machines are overkill for most of the people here, but those of us with more complicated conditions like to keep informed about changes and advancements in therapy.

I don't know what the future holds and it could turn out that iVAPS is the direction I might go down the road. If anyone had told me four years ago that I would start using cpap equipment and eventually end up on the Trilogy, I'd have laughed until it hurt.

And look at me now....

You all keep talking about it, I promise I will be reading and following it...

The Stellar 150 vent offers iVAPS and now so does the S9 VPAP S/T w/iVAPS machine. If your hospital or DME happens to have one of those two machines, you might be able to arrange a comparison trial of iVAPS versus your current Trilogy AVAPS.

-SWS wrote:

Madalot wrote:You all keep talking about it, I promise I will be reading and following it...

The Stellar 150 vent offers iVAPS and now so does the S9 VPAP S/T w/iVAPS machine. If your hospital or DME happens to have one of those two machines, you might be able to arrange a comparison trial of iVAPS versus your current Trilogy AVAPS.

I just sent an email to my current Respiratory Therapist and the Manager of the Respiratory Department at my DME telling them if they had an iVAPS machine and needed a patient to give it a test run, I was volunteering!!

Interestingly, my RT just replied that they are meeting with their ResMed Rep very soon and will be asking him/her about the iVAPS machines. My RT seemed excited by this. I reiterated that I would be very interested in testing the equipment if they wanted a patient "guinea pig" -- I'll post if anything comes of it.

Sir NoddinOff wrote: Apples and oranges in my opinion.

I agree with your apples and oranges comment: ASV machines correct transient hypocapnic problems by encouraging CO2 retention; conversely AVAPS & iVAPS machines correct hypercapnic problems by encouraging CO2 depletion. Regarding CO2 correction, the two treatment platforms are polar opposites.

Madalot wrote:Interestingly, my RT just replied that they are meeting with their ResMed Rep very soon and will be asking him/her about the iVAPS machines. My RT seemed excited by this. I reiterated that I would be very interested in testing the equipment if they wanted a patient "guinea pig" -- I'll post if anything comes of it.

Fingers crossed!

-SWS wrote: Hey, Slinky! Good to hear from you. Resmed states that hypercapnic patients are the ones most likely to benefit from iVAPS. Anyone with advanced COPD is probably keeping periodic tabs on CO2 retention. If you discover that you're hypercapnic, then an iVAPS or AVAPS trial probably makes sense. ...

Last ABG (several years ago) I wasn't retaining CO2 to any degree but a recent basic metabolic panel blood draw (last week) indicated CO2 greater than 40 w/the normal range being 22-34. I hadn't been aware that they could get any CO2 results from a venous blood draw but evidently they can. I was on 2L of 02 but have been upped to 4L. Can't do the 4L w/VPAP tho, gotta drop it to 2L whilst on VPAP or I get sicker than a dog, nauseous, burpy, etc. etc.

Slinky wrote: I was on 2L of 02 but have been upped to 4L. Can't do the 4L w/VPAP tho, gotta drop it to 2L whilst on VPAP or I get sicker than a dog, nauseous, burpy, etc. etc.

Aggressively adding oxygen can sometimes reduce the drive to breathe, Slinky. If that happens, then hypercapnia can result as secondary to the reduced drive. I'm thinking that's probably what happened when you upped to 4L. The nausea was probably symptomatic of hypercapnia secondary to having reduced your respiratory drive.

As reference of what I just described, see the yellow text I have highlighted in this book: BASICS of BLOOD MANAGEMENT, by Petra Seeber and Aryeh Shander.

You know what, Slinky? I think you should ask your doctor to arrange a trial on iVAPS or AVAPS on that next visit. It sounds as if it's time to start nudging those CO2 levels down.

-SWS wrote:. . . low-level design differences . . .

Such as . . . ?

Any iVAPS-vs.-AVAPS scouting reports at this point from what you've read/heard/seen, -SWS? Or do we just have to wait?

I just did a quick search for ResMed's Stellar 150 Ventilator (which has iVAPS). The information I could find wasn't as detailed as I would like so I'm asking....

Is this ResMed's equivalent (or comparable) to Respironics Trilogy series? If so, it appears to be a lot smaller than the Trilogy. I'm going to keep looking (as I have time and energy) but I am curious.

My RT said her meeting is very soon and she was going to inquire about allowing a patient (me!!) to test their new technology.....

Madalot wrote:I'm hoping we see more about this here as well. I know that these machines are overkill for most of the people here, but those of us with more complicated conditions like to keep informed about changes and advancements in therapy.

I don't know what the future holds and it could turn out that iVAPS is the direction I might go down the road. If anyone had told me four years ago that I would start using cpap equipment and eventually end up on the Trilogy, I'd have laughed until it hurt.

And look at me now....

You all keep talking about it, I promise I will be reading and following it...

Good luck. One thing I've learned here is that there's a lot of art vs. science involved in treating breathing problems. For instance, many people feel that one machine feels much more comfortable than another brand that has the same settings.

archangle wrote:

Madalot wrote:I'm hoping we see more about this here as well. I know that these machines are overkill for most of the people here, but those of us with more complicated conditions like to keep informed about changes and advancements in therapy.

I don't know what the future holds and it could turn out that iVAPS is the direction I might go down the road. If anyone had told me four years ago that I would start using cpap equipment and eventually end up on the Trilogy, I'd have laughed until it hurt.

And look at me now....

You all keep talking about it, I promise I will be reading and following it...

Good luck. One thing I've learned here is that there's a lot of art vs. science involved in treating breathing problems. For instance, many people feel that one machine feels much more comfortable than another brand that has the same settings.

That's my thinking as well. I'm doing pretty well on the Trilogy now, but it sure wouldn't hurt to give ResMed's equivalent a spin just to see *IF* their technology/algorithms are different enough to provide even better treatment.

Since I've been on AVAPS over three years now, I'm open to being a guinea pig!!