"please keep me updated about oximeters "
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ASV vs. CPAP
Replies to This Discussion
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Permalink Reply by Laurie Gelb on
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Thanks so much for linking to this PDF. I used it to tweak settings on a newly-acquired Respironics BiPAP S/T.
j n k said:Not quite the same machine, but this is close, as far as a provider manual:
http://www.internetage.ws/cpapdata/manuals/BiPAP-AVAPSProvider-%20M...
RichM said:Yes this is very well done. to bad I don't have a resmed machine. I got a Respironics Bipap S/T. I have not found anyone else that uses this machine yet.
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Permalink Reply by Neal Buckner, LRCP on
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In short. ASV target a minute ventilation and makes adjustments from breath to breath to ensure the total minute ventilation is consistant. It will automatically adjust the EEP to over come vibration and obstructive apneas. The IPAP is changed based on the previous 5 breaths and if the target MV is going to be reached. And machine triggered breath is intiated if a spontaneous breath has not happened with in the time the ASV has calulated as a needed respiratory cycle to achieve the MV. This is how centrals are over come. TV and RR is constantly being monitored. IPAP max and EPAP min are programed in with a PS max. Given those parameters the ASV will make adjustments to ensure proper ventilation and gas exchange.
Clear as mud now? lol
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Permalink Reply by RichM on
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I finely got a new Dr and a new overnight test and they found that I really needed the ResMed VPAP Adapt SV so I have it now and I am getting a lot better sleep then I have been for the past few years. The only problem that I have now is I can get the software and the cable to get the info off the machine so that I can monitor it like I did with the Bipap s/t I had. Does anyone know how to get this stuff, so I can monitor my data ?
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Permalink Reply by Mary Z on
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You need a nine pin null modem cable, and since most nine pin cables are male, you need a male to female adaptor. I bought it all separately - the nine pin cable (to USB), a male to female adaptor, and a null modem connector from Radio Shack. It has to be a null modem cable or connector (adaptor).
RichM said:I finely got a new Dr and a new overnight test and they found that I really needed the ResMed VPAP Adapt SV so I have it now and I am getting a lot better sleep then I have been for the past few years. The only problem that I have now is I can get the software and the cable to get the info off the machine so that I can monitor it like I did with the Bipap s/t I had. Does anyone know how to get this stuff, so I can monitor my data ?
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Permalink Reply by Bill Shoemaker on
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Hi Mike,
Here are some of the FAQ from Respironics. Respironics and Resmed use two different algorithms for their machines, so what Respironics says may not apply to Resmed at all.
Respironics: BiPAP autoSV
On the Respironics BiPAP autoSV:
What is the BiPAP autoSV device used for?
The intended use is: To provide non-invasive ventilatory support to treat adult patients with OSA and Respiratory Insufficiency caused by central and/or mixed apneas and periodic breathing.
What does autoSV mean?
autoSV stands for automatic Servo Ventilation. This is a pressure support ventilation which will be automatically delivered as soon as the patient drops under a certain flow value.
How does the algorithm operate?
The algorithm is based on flow. Using proven RI technologies such as Digital Auto-Trak, the flow signal is analyzed and a target flow is calculated. If the patient reaches the flow target, the device does not offer any additional pressure support. If the patient does not reach the flow target the device will dynamically change pressure support breath to breath.
Does the BiPAP autoSV operate like an Auto CPAP or Auto Bi-level device for treating obstructive events?
No – The device does not have an auto-titrating algorithm to alleviate obstructive events. The innovative algorithm was designed to treat complex apnea and periodic breathing. The obstructive component of SDB is treated utilizing a clinician adjustable CPAP or BiPAP pressure level.
Which patient types can utilize the device?
The device is designed to treat complicated breathing patterns. Complicated breathing patterns are mixed breathing patterns with OSA, Central, Mixed/Complex Sleep apneas and periodic breathing components, such as Cheyne-Stokes Respiration (CSR).
Is it necessary to titrate these patients?
Yes. To treat the complexity of this patients as well as establish a baseline CPAP or BiPAP pressure for OSA, an in lab titration is necessary.
Which type of mask I can use with this device?
The BiPAP autoSV can work with almost every mask type. However, controlling unintentional leak is very important for the algorithm to work effectively. If a patient presents with higher than expected leaks, move them to a full-face type of mask. (My comment: Respironics is much less sensitive to mask type than Resmed. I am successfully using nasal pillows with my BiPAP autoSV with pressures as high as 20, now 15.)
How long does it take before the patient’s periodic breathing is stabilized?
After 2 – 4 cycles of periodic breathing the patient’s breathing pattern is typically stabilized.
Which modes are possible with the BiPAP autoSV?
BiPAP autoSV is intended to be used as an auto-servo ventilator. However a variety of therapy treatments are available utilizing the 3 different pressure settings on the device. (EPAP, IPAPmin, IPAPmax). With these three pressure settings the device can be set to deliver CPAP, CPAP with autoSV, BIPAP and BiPAP with autoSV
Is it possible to use BiPAP autoSV patients with COPD, OHS and NMD?
The BiPAP autoSV is designed to treat complicated breathing patterns in sleep patients. Nevertheless, utilizing the 3 different pressure settings and a standard backup rate of 4 -30bpm, the device can be set similar to that of a standard S/T device. The ASV algorithm is not able to assure a volume which would be most beneficial for these types of patients.
Is a Bi-level S/T device better for these patients (COPD, OHS and NMD)?
A Bi-level ST device would be better for these types of patients. Experience with the VPAP adapt on these patients showed that over time the device can not treat them as well.
Will the patient require an in-lab sleep study with our BiPAP autoSV in order to be placed on the device at home?
Yes. To treat the complexity of this patients as well as establish a baseline CPAP or BiPAP pressure for OSA, an in lab titration is necessary.
I have been on my BiPAP autoSV since last August. If you have mixed SA, as I do, the machine is a godsend. I have never tried the Resmed machine, but I have seen it referred to as the "Breath Nazi," because it drives breathing in a pretty intrusive manner. Good thing my Dr. had this machine available to him as he was an idiot who put me on it without titration or a sleep study, both of which Respironics says are necessary. He's gone now, and good riddance to him.
Happy Naps,
Bill
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thanks for the info... how can I get the s/w to get the data off the machine and run the reports?
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Rich, which machine do you have?
Mary Z.
RichM said:thanks for the info... how can I get the s/w to get the data off the machine and run the reports?
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You can find the software, the latest version at www.apneaboard.com. Look under clinicians manuals.
What kind of hardware interface do you have for dowloading your info? The male 9 pin?
Mary Z.
RichM said:Mary Z, I have the ResMed VPAP Adapt SV enhanced version.
Thanks
Rich
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The first thing the asv units treat central, complex sleep apnea. It works buy using preassure support that it self adjust to the patients breathing pattern, the unit takes a snap shot of the breathing pattern 15 times a min and adjust to eliminate all SDB. It pretty complex but it works I have several patients on them.
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1) tried CPAP - 19 forget it.
2) tried BiPAP 13/19 - forget it.
3) dr then said I needed ASV, but he had the same levels set. not only could I not take the 13/19, but the asv was almost always out of sync with my breathing that I simply could not fall asleep, even in the ramp mode.
4) getting an auto titrating machine, which is what I asked for originally.
It has taken 9 months for me to get what I asked for up front. I will be trying the auto titrator, which is set at 4-11. The doctor finally said that it did not look like I received any benefit from a pressure greater than 11, and that around 13 I started having centrals. I reminded him that I told him the exact same thing 8 months ago after I reviewed the details of my own sleep study and he just said, well, sometimes I don't hear what patients say.
moral of the story is: just because you're talking to a medial professional does not mean they will act like you expect them to, nor that they will actually listen to you. no one knows your body better than you. if something doesn't feel right get in their face and make them listen!
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