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What Is The Importance Of Pressure Support With A Bi-Level ???
I'm curious. I've had two bi-level titrations. Both came up w/a pressure spread of 5 cms. IPAP 13, EPAP 8 the first titration and IPAP 10, EPAP 5 the second titration. The Resmed Defualt Pressure Support is 4. Neither the first nor the second bi-level script made any mention of Pressure Support. Both times my Resmed VPAP Auto was set w/a Pressure Support of 4.
I have COPD and my experience has been that my pressure needs can vary rather significantly due to the COPD. (Witness the two bi-level titrations above). I see it in my own data from time to time. I can't help but question a 5 cms spread between IPAP and EPAP and a 4 cms Pressure Support.
I've wondered about a setting of IPAP 13, EPAP 5 but what about that Pressure Support, maintain it at 4 and if so, WHY?
I have COPD and my experience has been that my pressure needs can vary rather significantly due to the COPD. (Witness the two bi-level titrations above). I see it in my own data from time to time. I can't help but question a 5 cms spread between IPAP and EPAP and a 4 cms Pressure Support.
I've wondered about a setting of IPAP 13, EPAP 5 but what about that Pressure Support, maintain it at 4 and if so, WHY?
Views: 75
Replies to This Discussion
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Permalink Reply by Judy on
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jnk, I well remember your excellent description of the Resmed and the Respironics pressure support dances on the dance floor! I saved it. But there is NOTHING auto about setting a Resmed bi-level auto w/the PS = to the range between the IPAP and EPAP. At least not as I understand it. As much as I HATE to say it, and I CHOKE saying it, but I'm thinking w/the COPD I would do BETTER on the Respironics auto bi-level. (I can't BELIEVE I actually posted that in PUBLIC!!!!!). I think I need the fluctuation depending on the status of my COPD that particular night. Or what am I still not grasping?? To give you an idea: my Peak Flow can run from 110 to 210 L/M in the period of less than a month..
You had said:
As an illustration, think of inhale and exhale as being two dancers. On the Respironics dance floor in the Respironics world, the two dancers dance two different dances without caring what the other dancer is doing. You simply set the size of the dance floor and you tell the dancers the maximum distance they are allowed to get from each other during their separate dances (there is an automatic minimum to keep them from bumping into each other), and they each do their own thing. Sometimes they dance close to each other, and sometimes they dance far apart. That distance varies. On the other hand, on a ResMed dance floor in the ResMed world, the two dancers do the same dance and are always the exact same distance from each other, but they can still roam the full dance floor, as long as they do it together. So if you mistakenly set the fixed distance of the dancers to be the same size as the dance floor, you keep the dancers from moving at all.
In other words, for the Respironics machine, you set the maximum IPAP and minimum EPAP (the size of the dance floor), then you set the MAXIMUM pressure support, or maximum distance allowed between the two separate pressures (dancers). For the ResMed, you similarly set a maximum and minimum (the dance floor), but then you set the ACTUAL pressure support, the fixed distance (or, difference) between inhale pressure and exhale pressure for the night. On that machine, those two pressures increase and decrease TOGETHER, NOT SEPARATELY, moment to moment, during the night (since the two do the same dance together).
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Yeah, the Peak Flow Meter to check expiratory pressure.
I'm sorry. I don't see the wisdom or the value of keeping the distance between IPAP and EPAP constant. I DO see the wisdom of pressure needed to maintain airway patency and a comfortable expiratory pressure so I also see the value of a maximum IPAP and a minimum EPAP.
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Permalink Reply by RockRpsgt on
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A bilevel unit attacks both apneas and hypopneas. An auto BiPap takes a proactive appraoch to doing this by adjusting the pressures as needed. The ASM guidelines suggest that the EPAP never be more than within 4cmwp from the IPAP. Ther is no limit as to how far apart they can be just how close. This is why you could end up with a prescription of 13/5 or 20/12. You having COPD the Bipap can actually serve as a minor stimulus to help keep you breathing smoothly. I hope that helps.
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Well, I bow to superior understanding and knowledge than mine but it is still something I'm gonna talk to my sleep doc about. It just is NOT sinking into my thick skull altho I've been a good girl and always maintained the PS that was set on my VPAP Auto. I just do NOT have ANY faith at all the that PS was set from any real knowledge, I'm convinced it was just easiest to use the Default setting than to exercise a few brain cells.
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That was ignorance on the DME's part, I bet, due to a lack of understanding about how a ResMed autobilevel should be set up.
That's a sucker bet, jnk. You get no argument from me on that one. And no money down either!!!
Problem is, most sleep docs don't know squat about machines, in my opinion.
You do NOT have an exclusive on this opinion either!!!! I'm willing to guess its in the realm of 80% or better of doctors don't know diddley-squat about the capabilities of today's xPAPs.
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Permalink Reply by bonesigh on
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I was surprise that my sleep doc didn't seem to know anything about my machine. You'd think you would want to know what kind of machines your patients use and how each one works. He didn't even know if it had a data card. Funny, I only just saw a sleep doc after 2 years of therapy. Kaiser insurance only sent me to the respiratory therapist and I didn't know any better!
j n k said:I agree with you Judy. If your autobilevel is set with a PS of 4, it is NOT set according to your prescriptions, either of them, if the numbers prescribed had a distance of 5 between them, both times. Your setup would be closer to what the doc prescribed if PS was set to 5.
I bet the DME set the IPAP Max to what the doc prescribed as IPAP and set the EPAP Min to what the doc prescribed as EPAP then left PS at the default, 4. That was ignorance on the DME's part, I bet, due to a lack of understanding about how a ResMed autobilevel should be set up. I would trust your doc more than your DME about how your machine should be set up.
Problem is, most sleep docs don't know squat about machines, in my opinion. Only the good ones do.
Judy said:Well, I bow to superior understanding and knowledge than mine but it is still something I'm gonna talk to my sleep doc about. It just is NOT sinking into my thick skull altho I've been a good girl and always maintained the PS that was set on my VPAP Auto. I just do NOT have ANY faith at all the that PS was set from any real knowledge, I'm convinced it was just easiest to use the Default setting than to exercise a few brain cells.
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As a sleep tech we are given very little education on the end user machines. i have had to go out of my way to educate myself on the difference in the machines. judy and jnk have fed me a great deal of knowledge on this matter. they are my experts.
bonesigh said:I was surprise that my sleep doc didn't seem to know anything about my machine. You'd think you would want to know what kind of machines your patients use and how each one works. He didn't even know if it had a data card. Funny, I only just saw a sleep doc after 2 years of therapy. Kaiser insurance only sent me to the respiratory therapist and I didn't know any better!
j n k said:I agree with you Judy. If your autobilevel is set with a PS of 4, it is NOT set according to your prescriptions, either of them, if the numbers prescribed had a distance of 5 between them, both times. Your setup would be closer to what the doc prescribed if PS was set to 5.
I bet the DME set the IPAP Max to what the doc prescribed as IPAP and set the EPAP Min to what the doc prescribed as EPAP then left PS at the default, 4. That was ignorance on the DME's part, I bet, due to a lack of understanding about how a ResMed autobilevel should be set up. I would trust your doc more than your DME about how your machine should be set up.
Problem is, most sleep docs don't know squat about machines, in my opinion. Only the good ones do.
Judy said:Well, I bow to superior understanding and knowledge than mine but it is still something I'm gonna talk to my sleep doc about. It just is NOT sinking into my thick skull altho I've been a good girl and always maintained the PS that was set on my VPAP Auto. I just do NOT have ANY faith at all the that PS was set from any real knowledge, I'm convinced it was just easiest to use the Default setting than to exercise a few brain cells.
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I believe that for an auto bipap to fully be efficient that the ps should be auto also. The EPAP should stop raising when the apnes are fixed. This does not always stop the hypopneas though. if the EPAP is raised with the IPAP to adjust for hypopneas you could end up with an uncomfortable therapy. (Over titration)
Judy said:Yeah, the Peak Flow Meter to check expiratory pressure.
I'm sorry. I don't see the wisdom or the value of keeping the distance between IPAP and EPAP constant. I DO see the wisdom of pressure needed to maintain airway patency and a comfortable expiratory pressure so I also see the value of a maximum IPAP and a minimum EPAP.
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