10-22-2020, 09:43 PM
RE: All day dyspnea, have had jaw surgery and a trach to "fix" it. Looking for a bipap
Adding info to help define AVAPS generically or iVAPS the ResMed intelligent variant:
See this website as source for the following: https://www.aastweb.org/blog/what-is-ava...ndications
"What is AVAPS?
AVAPS is average volume-assured pressure support. It is a noninvasive technology developed to ensure delivery of a fixed tidal volume; how much air is moving in or out of the lungs with every respiratory cycle, along with the benefits and convenience of pressure support ventilation.
What does the AVAPS rate mean?
With the AVAPS rate setting, you are able to adjust the pressure support maximum rate at which the device automatically changes in order to achieve the target tidal volume. The AVAPS algorithm changes pressure support quicker at a higher rate to meet the target tidal volume. You can set this in 1 cm H2O per minute increments ranging from 1 to 5 cm H2O per minute.
What are the Indications for AVAPS?
There are various AVAPS indications, including:
It provides patients who have chronic respiratory insufficiency with noninvasive ventilation, and using EPAP treats Obstructive Sleep Apnea (OSA) in the AE mode. It also helps many chronic respiratory failure patients requiring ventilator support.
It is usually used in chronic hypoventilation patients, like those with neuromuscular diseases, Obesity Hypoventilation Syndrome (OHS), restrictive thoracic disorders, and Chronic Obstructive Pulmonary Disease (COPD).
It revolutionizes how Bi-Level therapy is provided to patients with breathing complications. The AVAPS device delivers a constant tidal volume of pressure to patients and uses a specific algorithm that automatically calculates the pressure changes needed to maintain an optimal tidal volume.
What Are the Benefits of AVAPS?
There are various benefits of AVAPS, including:
It can help many patients maintain their tidal volume.
It can assist patients with respiratory insufficiency because of restrictive and neuromuscular disorders where the respiratory effort will vary while they sleep.
It can help COPD patients at risk for hypoventilation.
It can help patients requiring non-invasive positive pressure ventilation (NiPPV) throughout the day.
It can help obesity hypoventilation (OHS) patients who might require compensation based on sleep stage and/or position changes.
Since during the rapid eye movement (REM) cycle of sleep, patients can have far worse hypoventilation, BiPAP with fixed pressure support (PS) might provide too much pressure in NREM sleep, leading to complex sleep apnea or intolerance, and might not give enough PS in REM sleep for controlling carbon dioxide (PaCO2) levels.
When Should AVAPS Not Be Used?
Patients should not use AVAPS if they require rapid inspiratory pressure (IPAP) adjustments for achieving the desired tidal volume. This means you should not see a change of over 2.5 cmH2O within a minute. Therefore, you should not use it for all patients.
What are the Settings Used for AVAPS?
The target tidal volume, depending on patient pathology can be set to 8ml/kg of the ideal weight.
The maximum IPAP equals 25 to 50 cmH2O which depends on the condition of the patient and the machine's available pressure.
The minimum IPAP equals EPAP + 4 cmH20 which depends on the patient's condition." AVAPS genrically.
Below is ResMed's website on info regarding iVAPS, their variant on AVAPS
https://www.resmed.com/epn/en/healthcare...ithms.html
iVAPS algorithms
At ResMed, we’re focused on improving patient compliance and providing comfortable, effective therapy. That’s why we continue to develop ventilators around iVAPS algorithms, an innovative technology that adapts to patients, especially those with Chronic Obstructive Pulmonary Disease (COPD). Learn more about COPD.
By targeting alveolar ventilation, iVAPS continually maintains ventilation according to the patient’s metabolic needs, decreasing the risk of over and under-ventilation with changing respiratory rate. Data from extensive bench testing against VAPS ventilators and clinical trials have shown that iVAPS effectively meets patients’ ventilatory needs. It also responds faster to respiratory changes without compromising patient comfort or sleep quality.
Volume assured pressure support (iVAPS) ventilators combine the advantages of pressure-support ventilation, such as patient comfort and patient-ventilator synchrony, with the assurance of a tidal volume target. However, while this enables VAPS modes to meet ventilatory needs, response to respiratory changes is slow. Another limitation of VAPS modes is the enforcement of a mandatory target tidal volume on every breath. Changes in breath rate will still trigger the same tidal volume to be delivered with each breath, which can lead to patient discomfort and sleep disruption.
Several clinical trials have been conducted to evaluate the iVAPS algorithm compared with the standard pressure-support ventilation (PSV) in different patient populations. Numerous studies have shown iVAPS to be as effective as PSV for the long-term management of ventilatory failure in stable COPD patients.1,2,3,4
References
Oscroft NS, Ali M, Gulati A, Davies MG, Quinnell TG, Shneerson JM, Smith IE. A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD. COPD 2010; 7:398-403.
Jaye J, Chatwin M, Dayer M, Morrell MJ, Simonds AK. Autotitrating versus standard noninvasive ventilation: a randomised crossover trial. Eur Respir J 2009; 33:566-573.
Battisti A, Tassaux D, Bassin D, Jolliet P. Automatic adjustment of noninvasive pressure support with a bilevel home ventilator in patients with acute respiratory failure: a feasibility study. Intens Care Med 2007; 33(4):632-638.
Kelly JL, Jaye J, Pickersgill RE, Chatwin M, Morrell MJ, Simonds AK. Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: Impact on adherence and physiological outcomes. Respirology (Carlton, Vic) 2014.
See this website as source for the following: https://www.aastweb.org/blog/what-is-ava...ndications
"What is AVAPS?
AVAPS is average volume-assured pressure support. It is a noninvasive technology developed to ensure delivery of a fixed tidal volume; how much air is moving in or out of the lungs with every respiratory cycle, along with the benefits and convenience of pressure support ventilation.
What does the AVAPS rate mean?
With the AVAPS rate setting, you are able to adjust the pressure support maximum rate at which the device automatically changes in order to achieve the target tidal volume. The AVAPS algorithm changes pressure support quicker at a higher rate to meet the target tidal volume. You can set this in 1 cm H2O per minute increments ranging from 1 to 5 cm H2O per minute.
What are the Indications for AVAPS?
There are various AVAPS indications, including:
It provides patients who have chronic respiratory insufficiency with noninvasive ventilation, and using EPAP treats Obstructive Sleep Apnea (OSA) in the AE mode. It also helps many chronic respiratory failure patients requiring ventilator support.
It is usually used in chronic hypoventilation patients, like those with neuromuscular diseases, Obesity Hypoventilation Syndrome (OHS), restrictive thoracic disorders, and Chronic Obstructive Pulmonary Disease (COPD).
It revolutionizes how Bi-Level therapy is provided to patients with breathing complications. The AVAPS device delivers a constant tidal volume of pressure to patients and uses a specific algorithm that automatically calculates the pressure changes needed to maintain an optimal tidal volume.
What Are the Benefits of AVAPS?
There are various benefits of AVAPS, including:
It can help many patients maintain their tidal volume.
It can assist patients with respiratory insufficiency because of restrictive and neuromuscular disorders where the respiratory effort will vary while they sleep.
It can help COPD patients at risk for hypoventilation.
It can help patients requiring non-invasive positive pressure ventilation (NiPPV) throughout the day.
It can help obesity hypoventilation (OHS) patients who might require compensation based on sleep stage and/or position changes.
Since during the rapid eye movement (REM) cycle of sleep, patients can have far worse hypoventilation, BiPAP with fixed pressure support (PS) might provide too much pressure in NREM sleep, leading to complex sleep apnea or intolerance, and might not give enough PS in REM sleep for controlling carbon dioxide (PaCO2) levels.
When Should AVAPS Not Be Used?
Patients should not use AVAPS if they require rapid inspiratory pressure (IPAP) adjustments for achieving the desired tidal volume. This means you should not see a change of over 2.5 cmH2O within a minute. Therefore, you should not use it for all patients.
What are the Settings Used for AVAPS?
The target tidal volume, depending on patient pathology can be set to 8ml/kg of the ideal weight.
The maximum IPAP equals 25 to 50 cmH2O which depends on the condition of the patient and the machine's available pressure.
The minimum IPAP equals EPAP + 4 cmH20 which depends on the patient's condition." AVAPS genrically.
Below is ResMed's website on info regarding iVAPS, their variant on AVAPS
https://www.resmed.com/epn/en/healthcare...ithms.html
iVAPS algorithms
At ResMed, we’re focused on improving patient compliance and providing comfortable, effective therapy. That’s why we continue to develop ventilators around iVAPS algorithms, an innovative technology that adapts to patients, especially those with Chronic Obstructive Pulmonary Disease (COPD). Learn more about COPD.
By targeting alveolar ventilation, iVAPS continually maintains ventilation according to the patient’s metabolic needs, decreasing the risk of over and under-ventilation with changing respiratory rate. Data from extensive bench testing against VAPS ventilators and clinical trials have shown that iVAPS effectively meets patients’ ventilatory needs. It also responds faster to respiratory changes without compromising patient comfort or sleep quality.
Volume assured pressure support (iVAPS) ventilators combine the advantages of pressure-support ventilation, such as patient comfort and patient-ventilator synchrony, with the assurance of a tidal volume target. However, while this enables VAPS modes to meet ventilatory needs, response to respiratory changes is slow. Another limitation of VAPS modes is the enforcement of a mandatory target tidal volume on every breath. Changes in breath rate will still trigger the same tidal volume to be delivered with each breath, which can lead to patient discomfort and sleep disruption.
Several clinical trials have been conducted to evaluate the iVAPS algorithm compared with the standard pressure-support ventilation (PSV) in different patient populations. Numerous studies have shown iVAPS to be as effective as PSV for the long-term management of ventilatory failure in stable COPD patients.1,2,3,4
References
Oscroft NS, Ali M, Gulati A, Davies MG, Quinnell TG, Shneerson JM, Smith IE. A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD. COPD 2010; 7:398-403.
Jaye J, Chatwin M, Dayer M, Morrell MJ, Simonds AK. Autotitrating versus standard noninvasive ventilation: a randomised crossover trial. Eur Respir J 2009; 33:566-573.
Battisti A, Tassaux D, Bassin D, Jolliet P. Automatic adjustment of noninvasive pressure support with a bilevel home ventilator in patients with acute respiratory failure: a feasibility study. Intens Care Med 2007; 33(4):632-638.
Kelly JL, Jaye J, Pickersgill RE, Chatwin M, Morrell MJ, Simonds AK. Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: Impact on adherence and physiological outcomes. Respirology (Carlton, Vic) 2014.
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