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First photos of new ResMed AirSense 11
#61
RE: First photos of new ResMed AirSense 11
Hey, guys, one thing I have been ruminating upon... What would be involved in increasing the amount of pressure support so that you wouldn't have to go to the vauto if EPR 3 isn't enough for you?

I guess my question is this: what is different about the blower on the vauto? Does it take fundamentally different hardware to get more pressure support than 3? (The vauto has a higher max pressure, too, correct? So it has an inherently stronger motor, right?) Is that inherently stronger motor required to get a pressure support of more than 3? Or is it more of a marketing decision to reserve the higher pressure support to the more expensive hardware?

Yeah, I'm dreaming that I'll unbox a brand-new Airsense 11 and go to set EPR and turn the knob and discover it goes higher than 3 and I don't have to figure out how to get a vauto when the only thing I need that the A10 can't give me  is more pressure support...
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#62
RE: First photos of new ResMed AirSense 11
During the early days of Covid-19, it was reported the Resmed firmware is what differentiates the different models. The mechanical components are the same. This came out when there were discussions about converting a CPAP to ventilator.
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#63
RE: First photos of new ResMed AirSense 11
(05-22-2021, 11:48 PM)Crimson Nape Wrote: During the early days of Covid-19, it was reported the Resmed firmware is what differentiates the different models.  The mechanical components are the same.  This came out when there were discussions about converting a CPAP to ventilator.

Wow -- I had forgotten this -- but yes, I remember seeing those reports, too!

You know, this brings up something that has bothered me since I first found out that the manufacturers were producing data-logging and non-data-logging versions of what they claim are machines with the same algorithms.

Ok, I've been a professional software developer for 36 years now. When I look at the information on that SD card in my machine, I'm seeing something that I recognize as a fundamental tool of my profession: print statements in the software writing out all of the data that the machine is using, and logging what it is doing as it runs. The purpose of these print statements is that this is -- practically speaking -- the ONLY way to know whether the software actually does, in real life, what the programmers INTEND for the software to do in reaction to all of the real-life ways that an apnea patient's body can behave while asleep.

When I look at the A10 Auto vs the A10 Elite, the only way that I can imagine that these two products could possibly have been engineered is this: First the engineers programmed the Auto prototype. The engineers and the QA team spent thousands of hours testing the software by pouring over the data on the card, testing every code path, and making sure that the machine did what it was supposed to do. Over that process, hundreds, thousands, tens of thousands of bugs were discovered, diagnosed, fixed. Then when the machine PASSED this QA process, they built a production line that could produce the prototype in production quantities. AFTER the SD card and its data had served as one of the bedrock parts of the QA process the engineers took their prototype and got their soldering gun out and unsoldered the connections that connected the SD card drive from the circuit board on the Auto, and it became an Elite.

So now you have a machine where it is impossible for the QA team to do any process that uses the card data to double-check that the machine does what it's supposed to do.

They just assume that ripping out the SD card drive does not cause latent bugs to manifest themselves.

The FDA just assumes that the Elite (the Elite that is impossible to test) works just like the Auto that has been tested.

The doctors, patients, insurance companies, DMEs, etc -- everyone has to just assume that the Elite does what the Auto does, even though there is no card to check.

...and we all know that when you assume you make an ass out of u you and me!

One of the most fundamental rules of safety engineering is that any change to a design, no matter how seemingly trivial, introduces the possibility of introducing a new error, and so requires a new, separate QA process post-change. Safety engineering is all about making it a pain in the ass to change anything, so that nothing gets changed without a damn good reason!

Ok, now we are talking about a medical device which is quite complex and sophisticated -- unlike something like a scalpel which is fundamentally just a sharp blade with a handle. It is used by completely untrained people outside medical observation -- unlike something like a robotic surgery device where the surgeon has years of training and experience. Its normal operating environment is a room where no one is conscious -- so even an "obvious to the most casual observer" problem will not be detected because no one is watching.

As a software developer who has spent literally thousands of hours tracking down software bugs, I will say that there is no fricking way that I would fall asleep using a cpap machine that does not produce detailed data. Ok, maybe if you could prove to me that the Elite is an Auto where they super-glued shut the door to the SD card slot, ok that I would accept as a trivial enough change that I would trust the machine.

But even that brings up a whole different problem: when the "brick" version of a machine is simply a somewhat-crippled copy of the full-function machine, the process of crippling the "brick" means that the "brick" is more expensive to produce than the full-function machine. (The savings of not buying the SD slot hardware is a few dollars. The engineering cost of doing this properly is orders of magnitude more than that.) So either the ResMed people are fricking insane, or the safety of the Elite is in serious doubt. Either way, I'm not going to sleep! (And, actually, the prospect that the ResMed people are fricking insane gives me serious qualms about strapping on a mask hooked to any machine that they have engineered.)

...wow, that turned into quite the middle of the night rant!
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#64
RE: First photos of new ResMed AirSense 11
You got it wrong, somewhat anyway,
All 4 of the models in the AirSense 10 line have a fully functional SD card. Also the Elite produces detailed data. It is the CPAP model that is the Brick producing only summary and compliance data.

The lowly "worthless" CPAP was proven capable of being, on a one off basis, converted into a functional CPAP/APAP/BiLevel/ASV in the A10 line for the purpose of relieving the Ventilator shortage caused by the Covid pandemic.
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#65
RE: First photos of new ResMed AirSense 11
(05-23-2021, 01:48 AM)Gideon Wrote: You got it wrong, somewhat anyway,
All 4 of the models in the AirSense 10 line have a fully functional SD card.  Also the Elite produces detailed data.  It is the CPAP model that is the Brick producing only summary and compliance data.

The lowly "worthless" CPAP was proven capable of being, on a one off basis, converted into a functional CPAP/APAP/BiLevel/ASV in the A10 line for the purpose of relieving the Ventilator shortage caused by the Covid pandemic.

Ok, so that's somewhat more comforting! (At least in the "ResMed not maliciously insane" front.) In all of these discussions of "bricks" I've been looking at it from the side of someone who has an anxiety attack just thinking about using a machine where I can't afterwards go back and audit its behavior. I'm like the auditor where the CFO refuses to show me the company's books -- my reaction is "what are they hiding?!?!?"

I'm also wondering just how you get FDA approval on a machine with only summary and compliance data? I thought that the FDA was pretty hardass about not just believing a manufacturer with no proof! (having seen firsthand that I can have an AHI of 7.9 and leaks like crazy all night and the machine gives me that ridiculous stepford-wife happyface for both)

Also, without data, how do you trust that your "hacked" CPAP isn't doing something evil and nasty to the covid patient?

(Ok, I'll admit it -- I have really serious trust issues when it comes to medical devices.)
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#66
RE: First photos of new ResMed AirSense 11
I do not suggest "hacking" your machine period. Covid was an unusual event with a serious shortage of ventilators. This is just "proof" that all A10 ResMed's are essentially the same. All ResMed has to show is that the algorithm works. Thus it is rare that we see a new algorithm (For Her) or an altered algorithm shows up in devices. This goes for any manufacturer.
Once it was proven the test was stopped, no effort was ever made to look at mass use of this. While a lot of us suspected this we never dreamt that it would include all A10s thru the ASV.
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#67
RE: First photos of new ResMed AirSense 11
The 10 is excellent, but I suspect a 10A to correct for pneumatic lock is warranted. The many instances of this point to a design problem rather than individual defective machines.
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#68
RE: First photos of new ResMed AirSense 11
I'm not sure what you mean by 'Pneumatic lock'. Can you explain it, please?

Two points of improvement that I've noticed (from the pictures) 1. The seal between the pneumatic block and the humidifier inlet is now on the humidifier; this makes for cheaper and easier replacement. 2. The connection to the heated humidifier tube no longer uses a flexible film printed circuit, which can crack and break.

Both those problems have affected my Autoset.
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#69
RE: First photos of new ResMed AirSense 11
block, blame it on my rapidly expanding geezerhood.
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#70
RE: First photos of new ResMed AirSense 11
Thanks to Philips, Resmed and the DMEs should not have any trouble moving out old inventory of AirSense 10's. I wonder if Resmed will be able to position themselves for an earlier than August launch of the new AirSense 11.
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