Aircurve VAuto PS...pros & cons

[SarcasticDave94]

Common, expected slight variance in numbers, like slight changes to tidal volume. I think they're within acceptable ranges with lower PS 5.0, not a drastic drop-off.

[alimama]

I suggest increasing your EPAP to 5-6 instead of PS, as a low EPAP may prevent you from calling out Co2

[WW4B]

Thanks for your input and therapy advice. My epap is usually set at 8.8 - 9.2. You advised to increase epap. Did you actually mean I should try to decrease my epap to 5-6. What would be the benefits or reasoning be for this trial change...could you please explain your reasoning. Always trying to learn. thank you. Attaching last nights nights chart trying an F40 and dropped PS to 4.8, did not like it...any recommendations ? 
   

[Sleeprider]

WW48, I don't agree you need an increased EPAP. Your settings of EPAP min 9.6, max 16.0, PS 4.8 means you have a range of 15.4/9.6 to 16.0/11.2 (IPAP/EPAP). The settings limit pressure changes to only 0.6 cm of pressure increase.  You might be better served with a maximum pressure of 18.0.  Your latest chart shows a couple clusters of positional apnea, visible where there are also spikes of flow limitation, so that is something to keep an eye on.  I  like this lower PS of 4.8 vs your previous PS of 6.0 and 5.8, and your tidal volume is actually higher.  I'm uncertain if you are using maximum IPAP to limit pressure changes, or if you would benefit from allowing the range to vary by up to 2.6 cm with the change to max 18.

We use EPAP to control OA events, and it's unclear what minimum EPAP is needed for you to do that, however it seems to me a big move to an EPAP min of 5-6 might not be a good idea.

[alimama]

你好！ WW4B， 很高兴认识你！ AHI指数是佩戴呼吸机患者治疗效果的参考，但受多种因素影响，如：1、面罩漏气是否能有效排出CO2、漏气量、漏气量大是否严重等。因面罩佩戴或管道连接损坏造成，影响治疗效果。 （大多数呼吸机都有漏气补偿机制，可以解决问题，但会影响睡眠的连续性。）

2. 是否因压力设置不当导致P95或P90的压力值与设定压力值不同，导致性能问题。正确的治疗压力应该是指90-95%时期的治疗压力，也就是95%情况下机器向使用者提供的压力值。我们建议您使用 CPAP 压力公式来计算您的治疗压力，并使用此计算的压力值来设置您的治疗压力上限。根据该计算，压力如下：Hoffstein [CPAP=(BMI × 0.16)+(NC × 0.13) (AHI × 0.04) -5.12]。同时，压力值不宜设置过高。我注意到您95%的时间里治疗压力值为15.76，平均14.62，AHI1.41，根据AHI，您的治疗效果非常好，佩戴口罩也没有漏气。我建议你使用Mirage FX代替药物，它可以有效去除CO2。您可以根据公式计算出您的治疗压力是否接近14.62。我的建议是EPAP：5，PS：4，IPAP：13。如果压力（PS）差异太大，会影响整个睡眠周期。这是我从事呼吸睡眠工作20多年的临床经验。我希望它可以帮助你。祝您度过愉快的一天！

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***  Moderator Note: Google Translation  ***

Hello! WW4B, Nice to meet you! The AHI index is a reference for the treatment effect of patients wearing ventilators, but it is affected by many factors, such as: 1. Whether the mask leakage can effectively discharge CO2, the amount of leakage, whether the leakage is serious, etc. The treatment effect is affected by the mask wearing or the pipeline connection damage. (Most ventilators have a leakage compensation mechanism that can solve the problem, but it will affect the continuity of sleep.)

2. Whether the pressure value of P95 or P90 is different from the set pressure value due to improper pressure setting, resulting in performance problems. The correct treatment pressure should refer to the treatment pressure of 90-95% of the time, that is, the pressure value provided by the machine to the user in 95% of the cases. We recommend that you use the CPAP pressure formula to calculate your treatment pressure and use this calculated pressure value to set your treatment pressure upper limit. According to this calculation, the pressure is as follows: Hoffstein [CPAP=(BMI × 0.16)+(NC × 0.13) (AHI × 0.04) -5.12]. At the same time, the pressure value should not be set too high. I noticed that your treatment pressure value was 15.76 95% of the time, the average was 14.62, and the AHI was 1.41. According to the AHI, your treatment effect was very good and there was no air leakage when wearing the mask. I suggest that you use Mirage FX instead of drugs, which can effectively remove CO2. You can calculate whether your treatment pressure is close to 14.62 according to the formula. My suggestion is EPAP: 5, PS: 4, IPAP: 13. If the pressure (PS) difference is too large, it will affect the whole sleep cycle. This is my clinical experience in more than 20 years of respiratory sleep work. I hope it can help you. Have a good day!

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