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Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
#11
RE: Anyone know the difference?
(11-19-2017, 07:51 AM)Walla Walla Wrote: ajack,
           He tested out at less than 45% LVEF so he didn't qualify for ASV.

Ajack; I am scheduled to meet the Wizard in three weeks after prodding and delivering charts to him. 
Walla is correct on the LVEF.  Not overweight and in fact was NOT even qualified for an M/I, but cardiologist said "that's how it is sometimes".
In his wisdom the Wizard prescribed the VATO and settings that produced AHI 52.51.  Why he disregarded the sleep study showing the ST to have the lowest AHI in the titration study (6.9), I have no idea.  My LVEF <45% was there for him to see and there would have been no reason for him to have me fail CPAP so he could justify an ASV. With authorization SR recommended adjustments that now have it down to 14-ish. SP02 seems to be doing quite well considering.
SERVE-HF has put the Indian-Sign on me (NO ASV).  This is why I'm trying to get my ducks in a row so I can wrangle the best machine for my condition that the Government will allow me to use when I get  to look behind the Wizard's curtain.
If the ST-A only has an alarm feature that the ST does not that answers my question. Another distraction to sleep I DO NOT need..  As SR and I kicked back and forth previously, 'who's to say something like an ST won't produce the same effects as ASV?' 
[It's a brilliant study that determines people with CHF will have a higher mortality than those without] Oh-jeez
 
In my feeble knowledge research it appears the ResMed AirCurve 10 ST has a iVAP function that would make IT the best option available to me. [Right or Wrong?]

Thanks for the guidance
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#12
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
Well that explained why no ASV Smile
At the end of the day It is possible that bipap and o2 may be best practice.
IF it is suitable. There is nothing wrong with a ST, it is a very good machine and you won't be getting substandard care. The ASV does control Chaney stokes better, but with <45 they seem to be protective.

video and report https://www.youtube.com/watch?v=s80VkJks8Ws
http://erj.ersjournals.com/content/erj/4...9.full.pdf
"Spontaneous-timed BPAP
There is consistent evidence that, in patients with HFrEF with severe CSA, BPAP-ST reduces the AHI [96,
108–110]. In one RCT, in HFrEF patients with severe CSA, BPAP-ST was more effective than CPAP [96].
While in HFrEF patients with hypocapnic CSA, CPAP and ASV led to an increase in PCO2, BPAP-ST did
not change PCO2, indicating that hyperventilation is maintained with this treatment.
Three trials reported that BPAP-ST improves LVEF [108, 109]. In the only RCT, the increase of LVEF in
the BPAP-ST group (26–31%, p<0.01) was not significantly different from the control intervention ASV
(25–27%) [110]."


this has some info
http://www.heartfailure.onlinejacc.org/c...6.016.full
https://link.springer.com/content/pdf/10...0047-y.pdf

these videos will help to see why asv isn't for you
https://www.youtube.com/watch?v=Nr08K5IfzzY&t=2331s
https://www.youtube.com/watch?v=EmHy_FO8T0I&t=1049s


IF the ivaps is suitable for <45. The st-a ivaps alarms can be turned off ..it's the auto vaps that may help over the ST. As well as ivaps, the ST-A also has standard ST mode option.

With the ST you have a fixed epap/ipap. The st-a ivaps has auto. The easiest way to think about it is cpap and auto cpap.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#13
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
Thanks a million ajack.  That is what I was looking for.  I was of the impression the 'A' meant something besides alarms and suspected it had an auto mode beyond what the ST had.  I'll peruse the reference material today.  You have probably given me the information I will need to  confront the Wizard!
Thanks
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#14
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
oops!
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#15
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
(11-20-2017, 12:36 PM)Walla Walla Wrote: oops!

Another day another learning experience Grin
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#16
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
I'd find a real wizard, you shouldn't have to explain anything. This is specialist stuff and is out of the hands of 95% of the DME and sleep doctors. I really wouldn't listen to me on a forum either, other than taking it as chatting to a neighbour. <45 is one number under <30 is another, it seems to be a sliding scale of probability of what you can use. What is your HFrEF
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#17
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
(11-20-2017, 01:07 PM)ajack Wrote: I'd find a real wizard, you shouldn't have to explain anything. This is specialist stuff and is out of the hands of 95% of the DME and sleep doctors. I really wouldn't listen to me on a forum either, other than taking it as chatting to a neighbour. <45 is one number under <30 is another, it seems to be a sliding scale of probability of what you can use. What is your HFrEF

40-45% last echo
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#18
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
That really isn't that bad, when preserved ejection is >50. Going by what I read, you are in 'lucky band' of hazard ratio. I wouldn't be surprised if you come home with a ST or avaps/ivaps

https://www.heart.org/idc/groups/heart-p...487684.pdf
HFpEF, Borderline 41% to 49% These patients fall into a borderline or intermediate group. Their characteristics, treatment patterns(they don't mean ASV), and outcomes appear similar to those of patient with HFpEF.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#19
RE: Anyone know the difference? [between AirCurve10 BiPAP ST and the ST-A]
(11-20-2017, 07:52 PM)ajack Wrote: That really isn't that bad, when preserved ejection is >50. Going by what I read, you are in 'lucky band' of hazard ratio. I wouldn't be surprised if you come home with a ST or avaps/ivaps

https://www.heart.org/idc/groups/heart-p...487684.pdf
HFpEF, Borderline 41% to 49% These patients fall into a borderline or intermediate group. Their characteristics, treatment patterns(they don't mean ASV), and outcomes appear similar to those of patient with HFpEF.

Interesting data that I have not seen before. There is an area between 45-50% that always was 'grey'.  Thought I was in the HFrEF but this shows my 40-45% is most probably in the HFpEF 'borderline' /w characteristics of 50%.
Much appreciated
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