"please keep me updated about oximeters "
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Question For The Sleep Techs AND RRT/RPSGTs
When you are doing a PSG titration ... does the software you are using indicate inspiration and expiration VOLUME? Does it indicate inspiration EFFORT? i.e. does it just tell you that the chest and abdomen are moving or is there an indication of the strength or effort of that movement??
I would expect that COPD could affect both inspiration volume AND inspiration effort. Well, even expiration effort and volume as well.
I would expect that COPD could affect both inspiration volume AND inspiration effort. Well, even expiration effort and volume as well.
Views: 36
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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Yes we can see inspiration and expiration volume. If you have good RIP belts to detect respiratory signal you can see the strength in the signal. We do not have a numeric measure though.
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Permalink Reply by Jim Nadolny, BS, CRT on
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COPD is usually accompanied by incresed accessory muscle use. Also, a prolonged expiratory phase. This could have an effect on effort and volume. When you have COPD, your inspiratory effort is certainly increased, however the volumes are smaller due to air trapping. So, I would expect to see MORE effort,and LESS volume. PSG's are used to identify sleep disordered breathing. A better tool for the study and diagnosis of COPD is a Pulmonary Function Test. It is an interesting thought though, the mix of these two diseases and their effect of one another, has me thinking...thanks Judy!
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You have to pay attention to COPD titrations as you can actually over titrate and cause a complete breathing cessation in these pts. This is due to the weekening of the pulmonary drive and the muscles involved in breathing. Not that I don't pay attention to all of my titrations. LOL. It is just a little different.
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Interesting. I did not consider the effects of hypoxic drive during titration. I can see how you would have to moniter these patients carefully.
Rock Hinkle said:You have to pay attention to COPD titrations as you can actually over titrate and cause a complete breathing cessation in these pts. This is due to the weekening of the pulmonary drive and the muscles involved in breathing. Not that I don't pay attention to all of my titrations. LOL. It is just a little different.
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Permalink Reply by Judy on
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Dang! It was the numerical measure that I was curious about. If there was any way that could be discerned.
My median Respiratory Rate was 21 bpm for the past month (my maximum was 25). So about half the night I am breathing twice as fast as would be normal for someone w/o COPD or other lung or breathing issues.
My 95th percentile Tidal Volume was 400 mL w/a maximum of 540 nL and a median of 300 mL and darn if I haven't forgotten what the norm is for someone w/o COPD or other lung or breathing problems but as I remember it this is quite shallow breathing.
The Resmeds don't seem to be geared to focus on volume and I'm wondering if that might have some influence on the "puff" in Spontnaeous mode.
The most likely suspect tho as I can determine is the Ti control. The Clinicians Manual says: "The VPAP Auto allows clinicians to specify a maximum IPAP time (ie the time the device spends delivering the inspiratory pressure during a spontaneous breath). Thus, if a patient develops mouth leak, the VPAP Auto automatically cycles to EPAP after reaching the maximum time set by the clinician."
Resmed suggests a formula of "Ti Max = (60 ÷ patient’s respiratory rate) ÷ 2" which would suggest a Ti Max setting of 1.4 seconds. According to Resmed "this will generally ensure that Ti Max is set slightly longer than the patient’s inspiratory time.".
I am of the opinion, given the "feel" of this "puff" at the end of inspiration, beginning of expiration, that the Ti Max is set too long and needs to be shortened.
I've got to give it a bit more thought but at this point am seriously considering changing the Ti Max setting, putting her back in Spontaneous mode and checking out this theory, maybe to 1.3 seconds or even 1.2 seconds.
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Thanks, Rock Hinkle and Jim Nadolny!!! You must have both replied while I was replying to Rock Hinkle's first reply.
I've got several PFT results, the most recent from Oct 2008, and I have Spirometry results from just this past March and June 2009 if they are of any interest.
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Judy i would like to let that settle for a minute. I will get back to you soon.
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Permalink Reply by Duane McDade on
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Even if the traces were numbered for amplitude , you could not trust the value displayed. You would have to have belts that would never move when the patient does. They would also have to compensate for body positions because the body changes shape as one goes left, right, prone, fetal postion etc, etc,...What you are able to do is look at the changes in effort by expanding the display to 120 seconds even 300 seconds then the picture becomes clear.....Centrals, Obstructive, Mixed, COPD, become easy to see. Trends can be observed in this manner. The more a technician sees various conditions the easier it gets. Again the human touch,
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Thats the tricky part, COPD or Centrals have to be diagnosed with the PSG because CPAP can cause a bad reaction. It's better to go strait to the VPAP etc, etc, Not to mention what the insurance co's will not for pay for if not done in that manner.
Jim Nadolny, BS, CRT said:Interesting. I did not consider the effects of hypoxic drive during titration. I can see how you would have to moniter these patients carefully.
Rock Hinkle said:You have to pay attention to COPD titrations as you can actually over titrate and cause a complete breathing cessation in these pts. This is due to the weekening of the pulmonary drive and the muscles involved in breathing. Not that I don't pay attention to all of my titrations. LOL. It is just a little different.
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While mulling this over, I began to pay more attention to the LCD screen while still awake w/mask and CPAP on. The screen usually shows the Settling time and because I am using the S8 ResLink and Nonin oximeter as well in additon to the Settling time it also displays the 02 saturation and PR. PLUS a down arrow.
So I pressed the Down arrow. The next screen displays Mode, Settling, IPAP, EPAP and Pressure Support plus a Down arrow.
Next screen shows Leak, Respiratory Rate, Minute Ventilation, Tidal Volume (I am assuming VT means Tidal Volume as the number would equate to that) and a Down arrow.
Next screen has an S and a C w/spaces between them that are either blank or have two ** that fluctuate as I inhale or exhale, the Ti Max and Ti Min AND a "ratio", for instance (I was awake and had just finished making the bed) 1:1.5 plus a Down arrow.
The next screen had the 02 saturation, Pulse Rate and Exit.
Duh! All this while mumbling and grumbling about the sleep profession offering no help w/the abrupt transistion of pressure changes in Spontaneous mode and I "think" the answer is right there under my nose on the LCD screen!!!!
Of course, it is rather difficult to read the LCD screen and go thru the Menu screens whilst you are sleeping - BUT - I think I can get pretty close if when I wake up during the night to go to the restroom I first go thru the LCD screen and read the Ti Max and Ti Min ratio before getting up. I "usually" still wake up once for a restroom trip and have no problems getting right back to sleep. I do remember the getting up tho.
Last night I slept right straight thru, no restroom trip, while one of the dogs growled and fussed and woke my husband who got up to check what had the dog so wary and ticked off and when he went back to bed he laid back down on the bed in the other room. I wasn't aware of ANY of it until I woke up this morning! How unusual! And it is usually ME who wakes up to the animals, not my hubby!
Anyway, I'm hoping I wake for my usual restroom trip tonight and remember to check the LCD screen and that Ti Max/Ti Min "ratio" or that I at least think to do so first thing when I wake up in the morning.
I'm feeling rather dense and dumb this morning that I didn't pay more attention to the LCD screen other than to check the Efficacy and Usage data in the morning!!! Duh! and Double Duh! The good Lord helps those who help themsevles and its about time I started doing so.
AND DUANE MCDADE!!! At 67 I do NOT need any reminders that the ole bod IS subject to the laws of gravity as it tosses and turns and changes position!!!! *wicked grin*
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No the Doctor knows that before the PSG. The deal is if you dont have Complex sleep Apnea as the result of your PSG. The Insurance Company will not pay for a PSG then CPAP then BI-LEVEL then VPAP! You have to have your act together. Your a Fisty Little one!!
Mollete said:Duane McDade said:
"Thats the tricky part, COPD or Centrals have to be diagnosed with the PSG..."
COPD can not be diagnosed with NPSG.
mollete
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So is your name Mollete or Holly? Are you French? palay vuxe 4 barrel
Mollete said:Duane McDade said:
"Thats the tricky part, COPD or Centrals have to be diagnosed with the PSG..."
COPD can not be diagnosed with NPSG.
mollete
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