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Plmnb - the journey continues now with ST-A.
#41
RE: Plmnb - the journey continues now with ST-A.
Post examples of 1:45 and 2:00

The reason the waves are flat topped is due to the rise time which is faster than APAP or VAUTO programming. Pressure hits IPAP earlier and holds higher pressure.
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#42
RE: Plmnb - the journey continues now with ST-A.
This doesn't look so good?

A ZOOM.  Video even shows me having strange breaths at this time.

   
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#43
RE: Plmnb - the journey continues now with ST-A.
Better but still not right.

Zoom at 4:13 to 4:15

   
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#44
RE: Plmnb - the journey continues now with ST-A.
What does 23:15 look like?

The PS helps improve flow through those flow limitations but man are they still ugly. Have you tried a cervical collar etc to try and hold airways in position?

I also assume you left RR at 16? That is too high and you can see how machine is using backup rate numerous times. I believe it should be 13-14 for you.
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#45
RE: Plmnb - the journey continues now with ST-A.
I agree the iBR rate is a bit too high. Notice where flow limitation is severe, that you are getting two IPAP pulses in the same breath cycle and inspiration time relatively short. We may need to increase TiMin to counter that momentary cycle to EPAP then resumption of IPAP. Let's increase Ti Min to 1.0.

Overall, this is a pretty good looking start UA events are limited, and there are a few H events we haven't really looked at. Pressure is generally lower than with your Vauto, but pressure support is consistently applied through the flow limitations. If we can sustain IPAP for the duration of inspiratory time, it should get better. It appears that the inspiration time chart accurately predicts the presence of flow limitation. I sure wish we had an understanding of the physiology of these flow limits.
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#46
RE: Plmnb - the journey continues now with ST-A.
I just changed Ti Min to 1.0s.  Target pt Rate kept at 16.

Geer1, I believe you have missed the cervical collar failure posts on my first main thread. Lol.

I’ll get the zoom requested to you in a few hours, headed out for a bit.

So if I understand correctly, Geer1 & Sleeprider, you are in agreement that the only change for now is the Ti Min?

Thanks all!

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#47
RE: Plmnb - the journey continues now with ST-A.
You also need to lower target pt rate to either 13 or 14. This is supposed to match your spontaneous respiration rate so base it off of your past results. I personally think you should lower target Va too, probably to 5 (I believe this would give a MV around 6) although I am a bit surprised by how your machine was reacting last night. I don't know if that was because of amount of leak or if it acts that much different than ASV. For example at 1:45 it should have been trying to blast you full of air but for some reason was not.

I figured you probably had tried collar etc but worth mentioning it again. Something is changing positions and like positional apnea it doesnt appear that increasing pressure helps overcome the restriction. It does blast more air through the restriction but doesnt look like it is capable of stopping the flow limitations from occuring once they get started.

Maybe a mouthpiece would work better than collar or chin strap if there was some reason they don't work? Loke sleeprider stated I wish we knew what causes this as then it might be more clear how to fix it.

You mentioned your breathing looked strange, possible to post a video showing the transition into that breathing and some of it? Windows has a built in movie editor and you can create an account on YouTube, when uploading can select for video to be unlisted so only people with the link can watch it.
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#48
RE: Plmnb - the journey continues now with ST-A.
(02-18-2020, 11:26 AM)Geer1 Wrote: You also need to lower target pt rate to either 13 or 14. This is supposed to match your spontaneous respiration rate so base it off of your past results. I personally think you should lower target Va too, probably to 5 (I believe this would give a MV around 6) although I am a bit surprised by how your machine was reacting last night. I don't know if that was because of amount of leak or if it acts that much different than ASV. For example at 1:45 it should have been trying to blast you full of air but for some reason was not.  

Thanks Geer1.  Very much appreciate your input.  If you don't mind I am asking Sleeprider for his input on your suggestions.  This is due to his following my journey from the very start, back in December, so he is real familiar with my situation.

I no longer have access to my old videos of "weird" breathing, they has some pretty extreme examples.  The best one of the recent examples actually underwhelmed my sleep doc.  But I will check.  Basically I have periods where my stomach and chest appear to be on one of those elevator drop rides.  Not to that extreme, but similar in basic nature.  And I "sleep" right through them, at least when wearing my mask and not doing my "yoga" position.

I await Sleeprider's input.

Regards,
Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#49
RE: Plmnb - the journey continues now with ST-A.
Geer,

The additional times you are requesting are during periods of LARGE LEAKS so the information in the graphs are not reliable for use.

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#50
RE: Plmnb - the journey continues now with ST-A.
You said you had to review video from last night. It would be best to view recent videos tied to the data to try and make a conclusion. Your body is going to react to these pressures differently.

Sleeprider proposed the same changes I did.

On post 45 sleeprider agreed backup rate is too high.

On post 35 sleeprider said he would probably lower target Va until MV was 6-6.4.

Periods during large leaks are fine to look at you just need to take them with a grain of salt. I don't get why your flow was so low and the pressure wasnt increasing which is what I was hoping to get hints on. Either the machine doesnt do what it is meant to do if leaks are that high(in which case having leaks under control is very important) or something strange was going on. I am not even sure if you were asleep as the reduced breathing seems to have happened straight from time after the machine was turned off?
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