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ResMed S9 VPAP S, Auto, Adapt w/ASV
#11
(04-28-2014, 07:31 AM)JohnNJ Wrote: I'm going to resurrect this thread because my friend has the results of his in-lab titration study.

The recommendation was for "BiPAP-ST therapy on 10/4 cm H2O and back-up rate of 10." The doctor said he would NOT need the S9 Adapt.

(04-28-2014, 10:32 AM)PaytonA Wrote: The S9 VPAP Auto has ST and T modes as well as the VPAP Auto and one level CPAP. I think that if John's choices are the ones that he mentioned, the S9 VPAP Auto would be the most adaptable.
The S9 VPAP Auto has only VPAP Auto, S, and plain CPAP modes; it does NOT have either ST or T modes. (See http://www.resmed.com/us/en/healthcare-p...-auto.html.)

The S9 VPAP ST has CPAP, S, ST, and T modes, but NO VPAP Auto mode. See http://www.resmed.com/ap/assets/document...ac_eng.pdf

The S9 VPAP Adapt has CPAP, ASV, and ASV Auto modes. See http://www.resmed.com/au/assets/document...ac_eng.pdf for details. Modes are listed on the last page under Therapy Features.

Each of these machines has a separate billing code (in the US) and requires a specific prescription.

A script that specifies either "bi-level" or "auto bi-level" is sufficient to get the S9 VPAP Auto, but it will not allow you to buy the S9 VPAP ST or S9 VPAP Adapt machine.

A script that specifies "bi-level with back rate" or "bi-level ST" or "bi-level T" will allow you to get the S9 VPAP ST machine, but it won't let you buy the S9 VPAP Auto or the S9 VPAP Adapt.

A script that specifies "ASV" or "bi-level ASV" or "Auto SV" will allow you to get the S9 VPAP Adapt, but it won't let you buy the S9 VPAP Auto or the S9 VPAP ST.

The friend's script specifies ST therapy with a specified backup rate; the only Resmed machine that can be set to the prescribed therapy is the S9 VPAP ST running in ST mode.

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#12
If I read the ResMed site correctly (here), the different modes are as follows. All are Bi-Level, so IPAP (inhale pressure) and EPAP (exhale pressure) are separately configurable.

"S" or "Spontaneous" mode only switches between IPAP and EPAP when it detects a patient inhale and exhale, except that it has a "failsafe" to limit IPAP duration, typically in the presence of leakage.

"T" or "Timed" mode keeps track of patient breathing rates (or is it a fixed configuration?) and provides IPAP and EPAP transitions at that period, with the IPAP duration apparently fixed. It will apparently "fight" the patient if they try to breathe outside of its timing.

"ST" or "Spontaneous-Timed" mode keeps track of patient breathing rates, and if the patient is breathing regularly, it behaves like in "S" mode. If, however, a breath is missed (based on the established breathing rate), the machine will transition itself to IPAP pressure.
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#13
(04-28-2014, 04:25 PM)RonWessels Wrote: If I read the ResMed site correctly (here), the different modes are as follows. All are Bi-Level, so IPAP (inhale pressure) and EPAP (exhale pressure) are separately configurable.

"S" or "Spontaneous" mode only switches between IPAP and EPAP when it detects a patient inhale and exhale, except that it has a "failsafe" to limit IPAP duration, typically in the presence of leakage.

"T" or "Timed" mode keeps track of patient breathing rates (or is it a fixed configuration?) and provides IPAP and EPAP transitions at that period, with the IPAP duration apparently fixed. It will apparently "fight" the patient if they try to breathe outside of its timing.

"ST" or "Spontaneous-Timed" mode keeps track of patient breathing rates, and if the patient is breathing regularly, it behaves like in "S" mode. If, however, a breath is missed (based on the established breathing rate), the machine will transition itself to IPAP pressure.
You have the S, T, and ST modes described correctly.

And to add to these "modes"

VPAP Auto (VAUTO) mode is like S mode except that the machine will increase both the EPAP and IPAP pressure (at the same time) in response to clusters of OAs and Hs, snoring, and flow limitations.

ASV mode is similar to T or ST mode in that there is a back up rate and if you don't inhale on time, the machine will switch from EPAP to IPAP. But in ASV mode the machine also monitors the tidal volume and minute ventilation numbers. If the minute ventilation falls under the 90% "target ventilation", the machine starts ramping up the IPAP on each inhalation even if breathing is still occurring. The "target ventilation" is based primarily on the last several minutes of "normal" breathing. The point of ramping up the IPAP is to trigger deep enough inhalations to prevent a CO2 undershoot/overshoot cycle from developing, which in turn prevents strings of CAs from happening.

T, ST, and ASV mode can all be considered forms of noninvasive ventilation since the machine is capable of attempting to trigger inhalations when the patient's breathing does not meet certain paramters. T and ST try to trigger inhalations by simply stepping in with a switch to IPAP (when the breathing rate is not sufficient). ASV machines increase IPAP quite drastically to trigger deeper inhalations when the target minute ventilation is not met by the patient's own breathing. My understanding is that noninvasive ventilators in a hospital setting use more sophisticates algorithms with more settings, but they are essentially based on a combination of algorithms similar to those found in the T, ST, and ASV machines.

S and VAuto modes are not usually considered forms of noninvasive ventilation since they do NOT try to trigger inhalations.
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#14
(04-28-2014, 04:14 PM)robysue Wrote:
(04-28-2014, 07:31 AM)JohnNJ Wrote: I'm going to resurrect this thread because my friend has the results of his in-lab titration study.

The recommendation was for "BiPAP-ST therapy on 10/4 cm H2O and back-up rate of 10." The doctor said he would NOT need the S9 Adapt.

(04-28-2014, 10:32 AM)PaytonA Wrote: The S9 VPAP Auto has ST and T modes as well as the VPAP Auto and one level CPAP. I think that if John's choices are the ones that he mentioned, the S9 VPAP Auto would be the most adaptable.
The S9 VPAP Auto has only VPAP Auto, S, and plain CPAP modes; it does NOT have either ST or T modes. (See http://www.resmed.com/us/en/healthcare-p...-auto.html.)

The S9 VPAP ST has CPAP, S, ST, and T modes, but NO VPAP Auto mode. See http://www.resmed.com/ap/assets/document...ac_eng.pdf

The S9 VPAP Adapt has CPAP, ASV, and ASV Auto modes. See http://www.resmed.com/au/assets/document...ac_eng.pdf for details. Modes are listed on the last page under Therapy Features.

Each of these machines has a separate billing code (in the US) and requires a specific prescription.

A script that specifies either "bi-level" or "auto bi-level" is sufficient to get the S9 VPAP Auto, but it will not allow you to buy the S9 VPAP ST or S9 VPAP Adapt machine.

A script that specifies "bi-level with back rate" or "bi-level ST" or "bi-level T" will allow you to get the S9 VPAP ST machine, but it won't let you buy the S9 VPAP Auto or the S9 VPAP Adapt.

A script that specifies "ASV" or "bi-level ASV" or "Auto SV" will allow you to get the S9 VPAP Adapt, but it won't let you buy the S9 VPAP Auto or the S9 VPAP ST.

The friend's script specifies ST therapy with a specified backup rate; the only Resmed machine that can be set to the prescribed therapy is the S9 VPAP ST running in ST mode.

Robysue,

I blew it. I did not find the information on the S9 VPAP S that you did. The S9 VPAP Auto however does have the following operational modes; Auto, S, T, ST, CPAP.
Please see http://www.resmed.com/content/dam/resmed...er_eng.pdf S9 VPAP Auto Information.

Best Regards,

PaytonA
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#15
(04-28-2014, 08:25 PM)PaytonA Wrote: Robysue,

I blew it. I did not find the information on the S9 VPAP S that you did. The S9 VPAP Auto however does have the following operational modes; Auto, S, T, ST, CPAP.
Please see http://www.resmed.com/content/dam/resmed...er_eng.pdf S9 VPAP Auto Information.
Payton,

I've read the entire document and I do NOT see where you are seeing a statement that the VPAP Auto has an T or an ST mode. The document appears to be a document that concerns three different machines (the VPAP Auto, VPAP ST, and the VPAP S), but it does not specify what modes are available in the Auto mode.

And I found this chart from Resmed on Supplier #10's website, but I can't seem to find it any more on the (badly) redesigned and reorganized Resmed/us website. (It used to be on the Resmed site in a place that was easily accessible). It clearly indicates that the VPAP Auto does NOT do ST or T mode.

[Image: s9-vpap-adapt-sv-data-guide_zps413a6822.jpg]

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#16
Robysue is correct as usual. I have 2 S9 VPAP Auto machines, one with older firmware and one brand new. Both machines have the same 3 therapy modes: VAuto, S, and CPAP, exactly as the chart says.
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#17
The following is page 8 of the S9 VPAP Auto Information. The sections under Mode Reading looked to me like it had S, ST, and T modes. Made sense to me since my S8 VPAP Auto has those modes. Sorry about my confusion.

S9
technical specifications
Pressure and flow state
Operating pressure range (measured at the mask):
4 to 20 cm H2O
(CPAP);
3 to 25 cm H2O
(VPAP)
Maximum single fault steady state pressure: 30 cm H2O -
if pressure exceeded
for > 6 sec; 40 cm H2O -
if pressure exceeded for >1 sec
Pressure measurement tolerance: ±0.5 cm H2O ± 4% of the measured reading
Flow measurement tolerance: ±6 L/min or 10% of reading, whichever is greater,
at 0 to 150 L/min positive flow

Mode reading
CPAP mode
Set Pressure: 4 to 20 cm H2O
S, ST and T modes
IPAP: 4 to 25 cm H2O; EPAP: 3 to 25 cm H2O
VAuto mode
Min EPAP: 4 cm H2O; Max IPAP: 25 cm H2O; Pressure support: 0 to 10 cm H2O

Physical
Nominal dimensions (L x W x H): 6.0" x 5.5" x 3.4" (153 mm x 140 mm x 86 mm)
Weight: 1.84 lb (835 g)
Housing construction: Flame retardant engineering thermoplastic
Air outlet: 22 mm conical air
outlet (complies with ISO 5356
-1:2004)
Air filter
Hypoallergenic air filter: Acrylic and polypropylene fibers in a polypropylene
carrier
Standard air filter: Polyester non-woven fiber



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#18
(04-29-2014, 09:46 AM)PaytonA Wrote: The following is page 8 of the S9 VPAP Auto Information.

The document you quote here is titled: "S9 VPAP Auto / S9 VPAP ST / S9 VPAP S" and it is a combined information document about three different machines: the S9 VPAP Auto, S9 VPAP S, and S9 VPAP ST.

The mode part that you've highlighted in GOLD synopsizes the ranges of available pressures in each of the various modes, but it does NOT specify which modes are available on which of the three machines.

I admit that this document is VERY confusing and, quite honestly, misleading in my opinion.

I also have to say that surprised that you say "my S8 VPAP Auto has those (T and ST) modes" since the only information I can find on S8 VPAP Auto 25 (aka S8 Auto 25 in Europe) indicates that it has VAuto (VPAP Auto) and CPAP modes, but nothing about T or ST modes. (See http://www.resmed.com/int/products/s8_au...c=patients.)

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#19
Just checked my machine, CPAP, AUTO, SPONT are my only three choices. My machine is labeled slightly different (no 'S8', or 'S9') just,

Resmed VPAP Auto 25

I do remember when I got it being told this was the 'newest machine on the market' - but am bad on dates and do not remember what year I got it.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#20
Guess I got caught by the same sort of documentation for my S8. I just went and checked my CPAP and it only comes up with 3 modes.

Best Regards,

PaytonA
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