(06-15-2014 10:29 PM)mwackerly Wrote: Can anyone tell me how to set the pressure level (EPAP setting) on a Res Med VPAP Adapt S9 series.
On the S9 VPAP Adapt model manufactured earlier than November 2012, EPAP is set manually to a fixed pressure, using the Clinician's setup menu. It is not able to auto-adjust to treat obstructive events.
Full details are provided in the Clinician Setup Manual for the S9 VPAP Adapt. Apnea Board members can request a copy of the Clinician Setup manual by email. (See link in post by diamaunt, above.)
To get into the Clinician Setup menu, one should push and hold down both the rotary knob and the rectangular button with two check marks (push and hold these down at same time) for about 4 seconds.
Once in the Clinician Setup menu, one would rotate the knob to highlight the Settings sub-menu, then push the rotary knob to enter the Settings sub-menu, then rotate the knob to highlight EPAP, then push the knob to begin editing the EPAP setting, then rotate the knob to adjust the setting to its desired value, then push the knob to put the setting into effect, and then rotate the knob to highlight any other settings which need to be adjusted (or highlight "Home" and push the knob to exit the Clinician Setup mode and go to the patient Home screen.
To adjust EPAP on S9 VPAP Adapt machines manufactured in November 2012 and later, the same method would be used, except the newer model has two EPAP settings (Min EPAP and Max EPAP), similar to the Philips Respironics System One BiPAP autoSV Advanced. EPAP is auto-adjusted to treat/prevent obstructive events.
The S9 VPAP Adapt also has settings for Min Pressure Support and Max Pressure Support. It is the automatic adjustment of Pressure Support which enables this ASV machine to treat central apneas.
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OR, are you asking not HOW to edit the settings but, instead, how to DETERMINE what the settings should be?
Ideally, a medical professional would have given you a prescription specifying all key parameters of treatment.
In my understanding, the basic concepts for what the settings should be is as follows:
EPAP is adjusted to avoid obstructive apneas and Flow Limitation (and Snore, I think) similar as in the S9 VPAP Auto or as in the S9 AutoSet. For example, if moving from an S9 VPAP Auto to the latest model S9 VPAP Adapt, one could set the Min EPAP and Max EPAP to the same range which was used on the S9 VPAP Auto. Or, if moving from an S9 AutoSet to the latest model S9 VPAP Adapt, one could use the same minimum EPAP pressure which was used on the AutoSet (which would have been the AutoSet's Min Pressure minus its EPR value, if EPR was used), and one could set the Max EPAP to the the maximum EPAP value used by the AutoSet (which would have been the AutoSet's Max Pressure minus its EPR value, if EPR was used). However, unlike the S9 VPAP Auto or the S9 AutoSet, a limitation of the S9 VPAP Adapt is that EPAP cannot go higher than 15 cm H2O.
If the EPAP is too low then exhalation will be partly obstructed, which, for example, could cause the Flow waveform to repeatedly "stop and go" during exhalation, as the air sort of gurgles past the obstruction in our airway. We might feel this gurgling and be partly awakened by it, or we might only see evidence in the Flow waveforms that EPAP was too low at times during the night.
In the S9 VPAP Adapt the Min Pressure Support is set to 3 cm H2O or higher, as per user preference, or higher if needed in order to maintain an adequate blood oxygen level as shown by a Pulse Oximeter.
In the S9 VPAP Adapt the Max Pressure Support must be at least 5 higher than the Min Pressure support, and usually should also be at least 10 cm H2O so that the machine will likely be able to automatically raise Pressure Support high enough to do all the work of breathing during a central apnea.