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All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
#11
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Adding info to help define AVAPS generically or iVAPS the ResMed intelligent variant:

See this website as source for the following: https://www.aastweb.org/blog/what-is-ava...ndications

"What is AVAPS?

AVAPS is average volume-assured pressure support. It is a noninvasive technology developed to ensure delivery of a fixed tidal volume; how much air is moving in or out of the lungs with every respiratory cycle, along with the benefits and convenience of pressure support ventilation.

What does the AVAPS rate mean?

With the AVAPS rate setting, you are able to adjust the pressure support maximum rate at which the device automatically changes in order to achieve the target tidal volume. The AVAPS algorithm changes pressure support quicker at a higher rate to meet the target tidal volume. You can set this in 1 cm H2O per minute increments ranging from 1 to 5 cm H2O per minute.
What are the Indications for AVAPS?
There are various AVAPS indications, including:

It provides patients who have chronic respiratory insufficiency with noninvasive ventilation, and using EPAP treats Obstructive Sleep Apnea (OSA) in the AE mode. It also helps many chronic respiratory failure patients requiring ventilator support.
It is usually used in chronic hypoventilation patients, like those with neuromuscular diseases, Obesity Hypoventilation Syndrome (OHS), restrictive thoracic disorders, and Chronic Obstructive Pulmonary Disease (COPD).
It revolutionizes how Bi-Level therapy is provided to patients with breathing complications. The AVAPS device delivers a constant tidal volume of pressure to patients and uses a specific algorithm that automatically calculates the pressure changes needed to maintain an optimal tidal volume.
What Are the Benefits of AVAPS?
There are various benefits of AVAPS, including:

It can help many patients maintain their tidal volume.
It can assist patients with respiratory insufficiency because of restrictive and neuromuscular disorders where the respiratory effort will vary while they sleep.
It can help COPD patients at risk for hypoventilation.
It can help patients requiring non-invasive positive pressure ventilation (NiPPV) throughout the day.
It can help obesity hypoventilation (OHS) patients who might require compensation based on sleep stage and/or position changes.
Since during the rapid eye movement (REM) cycle of sleep, patients can have far worse hypoventilation, BiPAP with fixed pressure support (PS) might provide too much pressure in NREM sleep, leading to complex sleep apnea or intolerance, and might not give enough PS in REM sleep for controlling carbon dioxide (PaCO2) levels.

When Should AVAPS Not Be Used?
Patients should not use AVAPS if they require rapid inspiratory pressure (IPAP) adjustments for achieving the desired tidal volume. This means you should not see a change of over 2.5 cmH2O within a minute. Therefore, you should not use it for all patients.

What are the Settings Used for AVAPS?
The target tidal volume, depending on patient pathology can be set to 8ml/kg of the ideal weight.

The maximum IPAP equals 25 to 50 cmH2O which depends on the condition of the patient and the machine's available pressure.
The minimum IPAP equals EPAP + 4 cmH20 which depends on the patient's condition." AVAPS genrically.


Below is ResMed's website on info regarding iVAPS, their variant on AVAPS

https://www.resmed.com/epn/en/healthcare...ithms.html

iVAPS algorithms
At ResMed, we’re focused on improving patient compliance and providing comfortable, effective therapy. That’s why we continue to develop ventilators around iVAPS algorithms, an innovative technology that adapts to patients, especially those with Chronic Obstructive Pulmonary Disease (COPD). Learn more about COPD.

By targeting alveolar ventilation, iVAPS continually maintains ventilation according to the patient’s metabolic needs, decreasing the risk of over and under-ventilation with changing respiratory rate. Data from extensive bench testing against VAPS ventilators and clinical trials have shown that iVAPS effectively meets patients’ ventilatory needs. It also responds faster to respiratory changes without compromising patient comfort or sleep quality.

Volume assured pressure support (iVAPS) ventilators combine the advantages of pressure-support ventilation, such as patient comfort and patient-ventilator synchrony, with the assurance of a tidal volume target. However, while this enables VAPS modes to meet ventilatory needs, response to respiratory changes is slow. Another limitation of VAPS modes is the enforcement of a mandatory target tidal volume on every breath. Changes in breath rate will still trigger the same tidal volume to be delivered with each breath, which can lead to patient discomfort and sleep disruption.

Several clinical trials have been conducted to evaluate the iVAPS algorithm compared with the standard pressure-support ventilation (PSV) in different patient populations. Numerous studies have shown iVAPS to be as effective as PSV for the long-term management of ventilatory failure in stable COPD patients.1,2,3,4

References
Oscroft NS, Ali M, Gulati A, Davies MG, Quinnell TG, Shneerson JM, Smith IE. A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD. COPD 2010; 7:398-403.
Jaye J, Chatwin M, Dayer M, Morrell MJ, Simonds AK. Autotitrating versus standard noninvasive ventilation: a randomised crossover trial. Eur Respir J 2009; 33:566-573.
Battisti A, Tassaux D, Bassin D, Jolliet P. Automatic adjustment of noninvasive pressure support with a bilevel home ventilator in patients with acute respiratory failure: a feasibility study. Intens Care Med 2007; 33(4):632-638.
Kelly JL, Jaye J, Pickersgill RE, Chatwin M, Morrell MJ, Simonds AK. Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: Impact on adherence and physiological outcomes. Respirology (Carlton, Vic) 2014.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Thank you so much dave! always appreciated. 

I rented a bipap for now, on S/T mode ipap max epap min(i hope it's enought tidal volume). It's coming in later i'm so excited.

If that doesn't work I'll try your recommendations, or just a straight up ventilator.

I'm in PH so it's hard to source certain equipment. 

I'm always grateful for your responses!
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#13
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Small update: the owner of the rental place increased my ipap to 20cmh20. maybe she sensed my desperation lol. I hope this can provide relief. I have a huge order set of cartoon portraits at work and I really needed this. hmm TMI sorry. Thank you to everyone who responded.

the rental place also provides ventilators, so i have an additional option if it doesn't work.
I really want to try iVAPS. i'll work my butt off and order a resmed astral soon.
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#14
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
The device is HERE!
it's ventmed a chinese brand but it has avaps, s, s/t and t modes! WOW

I rented it for 300$ a month but they're nice enough to sell it for $1200 if I decide to buy it.

Currently on S/T mode 30cmh20 inhale and 4cmh20 exhale. i/e rate of 33% It feels like 90% of the machine is doing the breathing for me!

The owner was nice enough to teach me how to reach the clinical settings so I can tinker more!

WHAT A RELIEF I'M SO HAPPY AFTER YEARS OF SEARCHING FOR A SOLUTION FOR MY CHRONIC PAIN.

I'm so happy I found a machine half the price of the resmed st-a with the same specs.

THANK YOU GUYS FOR ALL THE HELP.

I'll update in a week how I feel, but for now while I'm working, the pain is less. Big Grin
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#15
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
What are the settings on your rental now? What interface are you using (mask or trach)? It's too bad it is not compatible with OSCAR, so we can make some more informed suggestions to improve therapy.

I think it is important for you to understand how to use the settings and pressure support to your best advantage. The EPAP pressure is used to keep your airway patent during exhale. It prevents airway collapse and obstructive sleep apnea. EPAP can be set quite low if you don't need to protect against obstruction during exhale, which might be the case if you are using the Trach interface. IPAP establishes pressure support (PS) which is the difference in pressure between IPAP and EPAP. In your case, you want the machine to provide most of the respiratory effort, and to improve your respiratory volume. In general this requires a PS of 8.0 to 12.0 cm in the absence of pulmonary restriction. Most people will breathe without effort at these higher pressure support settings. What this means is, add the pressure support to your EPAP pressure to get IPAP. For example, if EPAP is 4.0, then IPAP should be set at 12.0 to 16.0 cm to provide the needed pressure support to replace muscular respiratory effort.

In most cases, using pressure support this high will require a backup rate. It sounds like you are in ST mode, but we don't know the breaths per minute (BPM) This is where the machine provides a timed breath if you do not spontaneously start a breath within a specified interval. For most patients the backup rate is set at 10 to 12 breaths per minute (BPM), allowing for spontaneous breathing, but providing a timed breath to maintain the respiratory rate as needed. To help you, we really need to know what your setup is going to be.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Hi dave i sent you a photo of my settings. Let me know what i should tweak.

It also has avaps i can send you a pic of the settings. But i can’t get the settings quite right.

Oh im using a trach, the rental place gave me a tube for actual ventilators. They said the exhale valve was important to avoid co2 build up.


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#17
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
You are using a pressure support of 26. In my opinion that is far too high to meet your needs, and we treat central apnea with a maximum of 15 cm. Please consider reducing IPAP to 20. If you need more, you will be the first to know, but over-ventilating is not a great idea. Everything else looks fine.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#18
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Hi sleeprider! Sorry i called you dave earlier, got confused
 
I set ipap to 20 and still feel the same relief. Thank you so much.

Pic attached

Pic here


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#19
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Nothing to add, it seems it's going well now for you. Best to you on the therapy.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Small update. Going through withdrawal from buprenorphine and fentanyl but back pain is less when sleeping.

I can’t tell if the nausea waking up is from the machine or my withdrawal.

I would love to try the avap settings but they’re confusing

currently on t mode i:20, e:4, i/e rate 20%(it seems to be controlling the amount of air kind of like tidal volume) and 15 breaths per minute
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