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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
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#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.
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#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.
PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 7cm. 
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#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
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#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.
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#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!
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