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Large Leak ASV Report Mystery
I'm attaching below a copy of the overview page of my friend's ASV report. His doctor says he's doing better than any patient he's ever seen, but I am not so sure. Why? I'm concerned about the large leak figure. Anyone else share my concern or see anything else I should be looking out for?
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Replies to This Discussion
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Permalink Reply by RockRpsgt on
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If I am reading this right his leak is 29.2 on a pressure setting of 11cmwp that is phenominal. I can only assume that since he is using an ASV model that he has Complex Apnea. If this is true an AHI under 10 is good under 5 excellent 2 PRICELESS! It is my understanding that their is no accurate cure for complex apnea. You can try any of the treatments out there, but it is a crap shoot. Some are proven to work better. No guarantees though. What will work for one case will have no affect on another. When one actually works for someone it is wonderful. Run with it.
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Permalink Reply by Judy on
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The Average Time Spent in Large Leak Per Day of 3 hours 33.2 minutes doesn't disturb you at all?
I suppose that could be due to the high average coming from the early days in acclimating to the ASV as I notice he must have had some acclimation problems given the 10 out of 52 days total usage that the ASV wasn't used and half of those 52 days using the ASV less than 4 hours. His average usage on the days he did use the ASV is only 4 hours and 1 minute.
I'd guess that he has to get a lot more compliant before we can put too much weight on his therapy data. I'm NOT challenging you, Rock Hinkle. I'm asking about the data that would have concerned me as a patient w/no training or medical background..
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The main thing is that the treatment is working for him. Yeah maybe the leake rate is hurting, maybe not. The dat a shows a success, the dr says success. You have to look at the big picture. He is compliant by present standards. Early in his treatment he has an AHI 2. He is showing progress. A couple of nights he almost slept for 7 hours. I do not put as much stock in leak rate as the rest of you. This to me is good data.
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You know one heck of a lot more about this than I do, Rock Hinkle. I'd trust your evaluation over mine any day!!!
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Permalink Reply by Mike on
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the doctor suspects that he may be pulling the mask off at points throughout the night, causing the large leak. i'm not sure. i guess there's no way to verify other than infrared camera taping him all nightlong, huh?
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As far as ASV and complex apnea goes no one has all the answers. I could ask 10 different exports the same questions and get 10 different answers. I am basing my opinion by observation and Dr's opinion alone. From what I have seen and read Duane would be the one to ask. He seems to have more experience than anyone else I know with these machines.
And Judy you are allowed and encouraged to challenge me any time you see fit.
Mike, I would encourage anyone who has the opportunity to video document their own sleep to do so. Make sure that they are prepared for anything.
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but the data is good. Even with a high leak his AHI is 2. Potentially bad does not mean bad. I understand that he needs to get that number under control, but overall he does not seem to be doing that bad. Right? If you look at compliance from 3/18/09 to 4/7/09 and then from 4/7/09 to 5/4/09 thi patient has taken some huge steps as far as his therapy goes. As a tech I could probably find a flaw in everyone's therapy on this site, but I am not a reality tv judge. I am a sleep tech. It is my job to help. His doc told him why he had a high leak it is his job to try and correct it. This pateint in the beginning of his ASV therapy has managed to get his AHI under 5 and is getting at least 4 hours of uninterrupted sleep a night. This to me is a successful therapy so far. Yes it needs some fine tuning. Yes it could be bad, BUT IT IS NOT BAD DATA! I have the potential to be bad. That alone does not make me bad.
Mollete said:Rock Hinkle said:
The Average Peak Flow refers to the patient's inspiratory pattern, not the average leak. At Large Leak, all parameters, as well as machine response, become suspect, so with 3'33" out of 4'1" per day in LL, this certainly has the potential of being absolutely awful.If I am reading this right his leak is 29.2 on a pressure setting of 11cmwp that is phenominal.
mollette
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I believe this data is a good start for this patient despite what anyone else thinks. Yes this therapy needs some work. Yes he needs to stop taking his mask off or get a mask that he can control the leak in, as long as he continues going in the right direction he should have some time to make corrections.You asked me to evaluate THIS data. If you look at the big picture this is a good start.
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I'll try to dredge up the detailed daily report from this gentleman, but it might take a little while.
Mollete said:Rock Hinkle said:
Further, without examining the specific settings (EPAP, IPAP min and IPAP max) one cannot tell whether or not an Average Peak IPAP Pressure of 11.1 cmH2O is "good" or "not so good". If the machine has been unnecessarily restrained by a low IPAP max, this may be limiting machine response. This would be seen by a "clipping" of the delivered IPAP in the Daily Details. Also, the Respironics Big Leak Control Layer of their algorithm for BiPAP historically not only overrides the apnea-hypopnea control layer, but reduces IPAP in an attempt to control leaks. Therefore, IPAP response could also be curtailed by that horrendous Large Leak.a pressure setting of 11cmwp that is phenominal.
Since this is only the single page Compliance Report, do you not have access to Daily Details? Do you have current data?
mollete
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You forgot to mention Rate, and rise time Mollet
Mollete said:Rock Hinkle said:
Further, without examining the specific settings (EPAP, IPAP min and IPAP max) one cannot tell whether or not an Average Peak IPAP Pressure of 11.1 cmH2O is "good" or "not so good". If the machine has been unnecessarily restrained by a low IPAP max, this may be limiting machine response. This would be seen by a "clipping" of the delivered IPAP in the Daily Details. Also, the Respironics Big Leak Control Layer of their algorithm for BiPAP historically not only overrides the apnea-hypopnea control layer, but reduces IPAP in an attempt to control leaks. Therefore, IPAP response could also be curtailed by that horrendous Large Leak.a pressure setting of 11cmwp that is phenominal.
Since this is only the single page Compliance Report, do you not have access to Daily Details? Do you have current data?
mollete
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