Breathing pattern identification, Flow limitations and posture

[Crimson Nape]

The AirCurve 10 CS PaceWave -Adaptive servo-ventilator device is an ASV and is used to treat CAs. The other two are the Bi-Level machines. Out of the two, the 10 V (pick of the litter) allows for both variable pressure settings and static settings, whereas the 10 S is static only.

- Red

[SingleH]

Thanks for clarifying Red,

I had a question as to how the BIPAP units would handle the "multiple inspiration" pattern shown on the Oscar screenshots.

With the stuttered inhalation sometimes the breath in goes below the zero line, as shown in the red circle in the screenshot below. How does the Bipap handles that. would that confuse the machine and make it think he is exhaling or does the machine maintain a fixed inhalation period before cutting pressure along the lines of the green line I have shown. I.E would it ignore the multiple inspirations?

   

[Sleeprider]

In the example posted, the slowly rising line is the end of expiration, before it sharply crosses zero flow where inspiration begins. this is normal expiration with most of the flow occurring early, then slowing flow as it ends. We often see an extended zero-flow which should also be viewed as expiration. The machines do get confused, and it helps to view the mask pressure graph along with the flow rate to see if the device is prematurely triggering IPAP.

The Aircurve S and Vauto sold in the EU seem to lack trigger sensitivity settings. This is a very useful setting,but for some reason is missing on the units we have seen in Europe.

[SingleH]

Thanks, I will check with Resmed UK about the sensitivity setting.

I did find a site that offers to rent an Aircure 10 for a trial, however it seems to be a different model again called the AirCurve 10 ST-A, which only appears on the Resmed US website. This seems to have a different set of features and not the Auto-bilevel so possibly not appropriate to use for a trial?

[SingleH]

Hi all,

Regarding flow limitations index is there a "normal" category or acceptable minimum level, like with AHI below 5 being considered normal?

What would be considered siginifcant flow limitations?

My fathers Flow limitation index figures fall between 6 and 9 on the pressures that control his AHI's best.

On a side note in OSCAR I note that Flow limit does not appear under statistics for the F&P sleeptstyle, but rather a single figure along with the leak and AHI average figure. There is no min, med 95% max

[Sleeprider]

Your statistics don't appear to provide a flow limitation index. With Resmed we like to see the 95% rate below 0.1 and inspiration equal or shorter time than expiration. Basically when looking at the flow rate chart, we can recognize flow limitation and obstruction pretty quickly when viewing at a 3-4 minute resolution. The most remarkable thing about the respiratory stats you posted is a high respiration rate of 25 breaths per minute. It might be worth looking at the flow rate to confirm if that is real or if your breaths are erratic or contain multiple peaks that cause a high resp rate to be interpreted.

[TryingToGetItRight]

SingleH, if you're paying out of pocket, there's a supplier here in the USA that ships internationally called Second Wind CPAP. I own two ResMed S9 VPAP machines that I purchased thru them over the years and they've always been helpful whenever I've had trouble with my machine.

If they don't have the exact brand and model you're interested in, they should know what machine does what you want.

[SingleH]

Thanks Sleeprider,

When you say it doesnt provide an index there is a figure below the Hypopnea Index in the image, 6.53. Is that not the index or did you mean a breakdown?

If I go to statistics I can get a monthly summary Index number, listing flow limitations.

Regarding the breating rate, yes the high respiration rate is due to multiple high peaks.

Ive attached a screenshot of a couple of 4 minute sections when there are flow limitations detected.

           

[SingleH]

Thanks TryingToGetItRight,

That is really useful, Im primarily interested in the Resmed Aircurve 10 Vauto, or possibly the Aircurve ST-A iVAPS as my father has scoliosis and I saw Resmed recommend that unit for restrictive lung disease.

Prices on the site that look good and seems like a lot of the units are new and unusued.

[Sleeprider]

Thanks Sleeprider,

When you say it doesnt provide an index there is a figure below the Hypopnea Index in the image, 6.53. Is that not the index or did you mean a breakdown?

If I go to statistics I can get a monthly summary Index number, listing flow limitations.

Regarding the breating rate, yes the high respiration rate is due to multiple high peaks.

Ive attached a screenshot of a couple of 4 minute sections when there are flow limitations detected.

I'm not used to looking at F&P charts which track flow limitation like a Philips machine. The FL index is based on events per hour rather than an index of the flow limitation through the night which ranges from zero to one.  I don't know what level of flow limitation is used to count a flow limit event. The zoomed screen shot shows there is a severe class 2 flow limitation. this is a soft tissue obstruction that in your case "flutters" several times during inspiration. Based on your mask pressure graph, you have no form of pressure support or EPR that would work to reduce that problem.  Also in the face of severe flow limits, your machine is not increasing pressure, which is needed to stent the airway.  In this chart we see EPR is OFF. You need to turn EPR on at the highest setting you can and may need a higher minimum pressure as well.