Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Benefits to higher pressures?
#31
(03-29-2017, 09:47 PM)AshSF Wrote: Since the main objective here is improving spo2, here is what I recommend:
1) Raise effective EPAP. This improves oxygenation by raising PEEP.
2) Have the maximum pressure support aka EPR. This raises oxygenation by improving co2 washout.

Looking at your graph, the first thing you should do is raise the minimum pressure to 7cm, preferably in 0.5cm increments for a week at a time. And keep EPR at 3. Evaluate the results and post it in this thread for further review.

I shall give this a try

thanks
Post Reply Post Reply
#32
(03-29-2017, 09:47 PM)AshSF Wrote: Since the main objective here is improving spo2, here is what I recommend:
1) Raise effective EPAP. This improves oxygenation by raising PEEP.
2) Have the maximum pressure support aka EPR. This raises oxygenation by improving co2 washout.

Looking at your graph, the first thing you should do is raise the minimum pressure to 7cm, preferably in 0.5cm increments for a week at a time. And keep EPR at 3. Evaluate the results and post it in this thread for further review.

This is not correct.  In bilevel, pressure support can increase ventilation supporting higher tidal volume.  This does have the effect of increasing CO2 exchange; however it is the higher positive end expiration pressure (PEEP) that supports oxygenation.  Using the Resmed Airsense 10 Autoset with EPR, oxygenation would be most improved by a higher minimum pressure and no EPR, for example a minimum pressure of 6.0 with no EPR would ensure better SpO2 results. 

If we also wanted to increase tidal volume, we need to support that PEEP of 6.0 cm.   This would mean with EPR at 1.0, minimum pressure should be 7.0. With EPR at 2, set minimum pressure at 8 and with EPR at 3 set minimum pressure at 9.0.

The reason Bexie...does not get better oxygenation is his PEEP is never over 4.0 because he is using maximum EPR. Nothing improves until PEEP is higher. The advise by AshSF results in a pressure of 7/4 which does not accomplish what is needed to improve oxygenation.
Post Reply Post Reply
#33
You are right as usual Sleeprider. But I wanted the OP to take the first step which would make sure he gets full benefit of EPR. Then he can start raising the min pressure above 7 this raising his PEEP above 4 keeping EPR at 3.

Jacking up the PEEP immediately may or may not be advisable since he is not your typical apnea patient.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
Post Reply Post Reply


#34
So what is suggested I start at from tonight and change over the next 2-3 weeks?
Something like this? But leave the machine on auto with max pressure remaining at 14?
epr 3 min pres 5
epr 3 min pres 5.5
epr 3 min pres 6.0
epr 2 min pressure 6.0
epr 2 min pres 6.5
epr 2 min pres 7
epr 2 min pres 7.5
epr 2 min pres 7.5
epr 1 min pres 8
epr 1 min pres 8.5
epr 1 min pres 9
Post Reply Post Reply
#35
Quote:Sleeprider
oxygenation would be most improved by a higher minimum pressure and no EPR, for example a minimum pressure of 6.0 with no EPR would ensure better SpO2 results...  With EPR at 1.0, minimum pressure should be 7.0. With EPR at 2, set minimum pressure at 8 and with EPR at 3 set minimum pressure at 9.0.
Maximum pressure does nothing for you because you don't have events that would normally cause pressure above 8 cm.  If your objective is primarily to increase SpO2  Your answer is above; the simplest being turn off EPR and set minimum pressure to 6.0.
Post Reply Post Reply
#36
(03-30-2017, 07:02 PM)Sleeprider Wrote:
Quote:Sleeprider
oxygenation would be most improved by a higher minimum pressure and no EPR, for example a minimum pressure of 6.0 with no EPR would ensure better SpO2 results...  With EPR at 1.0, minimum pressure should be 7.0. With EPR at 2, set minimum pressure at 8 and with EPR at 3 set minimum pressure at 9.0.
Maximum pressure does nothing for you because you don't have events that would normally cause pressure above 8 cm.  If your objective is primarily to increase SpO2  Your answer is above; the simplest being turn off EPR and set minimum pressure to 6.0.

This is sound advice!
Post Reply Post Reply




Possibly Related Threads...
Thread Author Replies Views Last Post
  losing weight and pressures Walla Walla 13 272 10-20-2017, 10:42 AM
Last Post: I_will_never_sleep_again
  [Treatment] Doctor wont raise settings higher... what now? sw33ttsunade 34 1,243 10-19-2017, 04:14 PM
Last Post: SarcasticDave94
  ASV users - effects of higher pressure vs CPAP? Stevie1under 7 287 10-05-2017, 05:47 PM
Last Post: Stevie1under
  High Pressures Possible w/ Nasal/Pillow Mask? JonnyCPAP 9 368 09-15-2017, 07:35 AM
Last Post: Shift Worker
  Different pressures for different masks? pollyottis 2 224 07-14-2017, 08:12 PM
Last Post: pollyottis
  [split] max / min pressures - comments please dgiebink 3 261 06-27-2017, 06:54 AM
Last Post: ajack
  Higher pressures = much higher hypopnea/events. Why? lostie42 3 438 06-19-2017, 11:01 PM
Last Post: Beej

Forum Jump:

New Posts   Today's Posts




About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.

For any more information, please use our contact form.