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Discussions of Respiratory Ventilation
#1
Discussions of Respiratory Ventilation
Quote:ADMIN NOTE:
This thread was split off from another discussion so that this issue of Respiratory Ventilation can be discussed separately.  Thanks.




I would zoom in and see if the median BPM is 18 and the tidal volume look to be the indicated 340. If they are right, I would keep increasing my PS till they came in range. I would also ask my doctor about it.
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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#2
RE: Five nights on new Aircurve Vauto
ajack,
He's having a problem with CA's. If you increased the Pressure Support you'd make it worse. I know you like to zero in on Tidal Volume but here's the problem. The guidelines for increasing pressure support for tidal volume was written with breathing backup in mind.
When you try to apply that without backup you end up causing a CO2 washout causing breathing to stop. Since there's no backup your making the problem worse not better.
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#3
RE: Five nights on new Aircurve Vauto
If the data is right. With a median respiration of 18 and tv 340. I would think CA of only 1.3 could be the least of the problems, if it were my chart. Bilevel with or without backup are for tidal volume from what I've read. A lot of issues don't need a back up rate. The trouble I find is that it's about 50/50 that the machine will miscount because of breath irregularities, found when it is zoomed in on. It isn't a foregone conclusion, it's a flag to investigate
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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#4
RE: Five nights on new Aircurve Vauto
The ResMed Sleep Lab Guide talks about increasing Pressure Support on VAUTO's until O2 levels are above 90% levels. No where does it say to increase Pressure Support until Tidal Volume is 500ml. If the oxygen levels are fine than the tidal volume is a non issue.

Now if it were a backup system than you have a reason to input tidal volume so the machine knows how much air to blow if there's no breathing. Also 12 - 20 is considered the normal range for respiratory rates so 18 is OK.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#5
RE: Five nights on new Aircurve Vauto
This has come up a few time, It might be a good idea if I make a thread on it. I will give the supporting data on why I say this stuff.
The resmed guide, as you know, I use that to give to people on lots of occasions, it is a very good, easy to understand bullet point guide. I'm sure you'll agree, there is more to titrating a BPAP, that those few words on a single page. I do have issues with the Vauto PS being commonly suggested as 3, when the resmed default for a normal lung is PS:6 and PS:8 for lung issues(page 22/23). The PS:3 or 4 is the start of a titration, the same as the min epap can start at 4. It's not the recommended setting. I've even uploaded and have used this link, as the resmed site link, is sometimes down (I'll post it for others who are reading the thread, will know what we are talking about.)
https://www.scribd.com/document/35340282...-Titration

I would look further into it. I don't think it is really that black and white. It seems you can be in respiratory failure with a very high BPM and still maintain reasonably O2 levels. It is the breathing effort that can be the problem.
obstructive/copd and restrictive/weak muscles lung conditions, both respond to PS. You can adjust the RR and tidal volume, through PS.
There is no need to have impaired respiration rate and tidal volume, when the BPAP is the ideal machine to correct it. Adding a back up or timed breathing rate is another issue and is independent to this.

I've seen it said, respiration of 12-16 as a normal range, when you are awake. The respiration rate also tends to reduce more, when you are asleep
https://www.hopkinsmedicine.org/healthli..._85,P00866

also it seems, respiration rate and tidal volume with minute ventilation, is the first thing to check and I would get right, then I would move on to epap/peep for apnea and then check o2.
https://www.youtube.com/watch?v=4Q3QcDgWg7g
[Image: XvFUnsk.jpg]
[Image: BFRMqzB.jpg]
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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#6
RE: Five nights on new Aircurve Vauto
(12-17-2017, 12:57 AM)ajack Wrote: This has come up a few time, It might be a good idea if I make a thread on it. I will give the supporting data on why I say this stuff.
The resmed guide, as you know, I use that to give to people on lots of occasions, it is a very good, easy to understand bullet point guide. I'm sure you'll agree, there is more to titrating a BPAP, that those few words on a single page. I do have issues with the Vauto PS being commonly suggested as 3, when the resmed default for a normal lung is PS:6 and PS:8 for lung issues(page 22/23). The PS:3 or 4 is the start of a titration, the same as the min epap can start at 4. It's not the recommended setting. I've even uploaded and have used this link, as the resmed site link, is sometimes down (I'll post it for others who are reading the thread, will know what we are talking about.)
https://www.scribd.com/document/35340282...-Titration
First let me point out that the pressure Support recommendations you quote are from the section addressing BPAP's with BACKUP.
I believe the primary reason that a minimum of 4cm Pressure Support is assigned to Bipap's by sleep centers has to do with ensuring justification for insurance purposes and nothing to do with proper treatment. If someone has central events at 4cm but not at 3cm why would you not use that?   

I go back to the point I made earlier if the Oxygen level is fine than there is no concern about Tidal volume. There is no point in trying to increase one's tidal volume if it serves no purpose. Now if a person requires a greater tidal volume to keep the oxygen levels at a normal level than I would agree. But in that case if a person were to experience centrals due to the large pressure support required than it's recommended they be put on a Bipap with Backup.

If your concerned about someones tidal volume being low the first thing you should recommend is they check their O2 level. If it's good than no problem. If not than they should see their Doctor.
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#7
RE: Five nights on new Aircurve Vauto
the example was to show that rr and Vt are the first things that are checked and during the titration, not the last.
..if you are breathing 25 times a minute with low volume to keep an o2 above 92%..I'd say there was a problem. even though the o2 level is fine. why would it be good for a person to pant all night, when some PS could help?

There isn't easy info on home machines, there is lots on hospital ones. The new ones also use different modes, so for us the older models are better to look at. Back up breathing rate has nothing to do with a normal bpap set up. this doesn't change whether it's a S or a ST, the basics are the same.
The timed backup is only for when you stop breathing, in hospital they normally set a min back up, whether you need it or not.

we should stop now and give the thread back to the OP. would you like to start another thread?
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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#8
RE: Five nights on new Aircurve Vauto
This is an interesting discussion, and I think both Walla and ajack are right. Ajack has a very good grasp of using non-invasive ventilation to modify Vt, Vm, rr, PEEP and other parameters, and Walla properly cautions that manipulating respiration can have consequences that a machine without a backup rate cannot address. I will add that on the forum, we rarely have sufficient information to judge whether ventilation should be targeted, since we know nothing of the individual's health, size, pulmonary issues or anything beyond the data given to us by a CPAP machine.

I am personally reluctant to go beyond an analysis of the events and wave forms someone might post. Suggesting changes to improve obstructive or central apnea or hypopnea for flow limitation is a lot different than getting into the depths of ventilation and an individual's pulmonary function. While we may be aware of Vt, rr etc, I do not think the forum is a qualified venue to recommend altering settings of member's xPAP machines with the objective of manipulating ventilation in any significant way. I just don't think any of us have the information or expertise to do more than make observations, suggest some references, and recommend a follow up with the member's doctor. Even that may be unnecessarily alarming.
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#9
RE: Discussions of Respiratory Ventilation
I'm not sure O2 is the only clinical data point relevant to determining if a person has adequate ventilation (what the tidal volume indicates). A person can maintain adequate O2 levels but not evacute enough CO2 to prevent respiratory acidosis. In fact, Bicarb levels or pCO2 levels are the fastest way to determine adequate ventilation. In our house we have a BiPAP user for OSA, and a VPAP user for neuromuscular disease... we do not look at the O2 levels to determine if our neuromuscular user is well-ventilated, we look at weekly plasma bicarbonate levels.
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#10
RE: Discussions of Respiratory Ventilation
jessica,
I wouldn't dispute how you test for pCO2. But your talking about treating something other than sleep apnea in regards to testing bicarbonate levels weekly.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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