Breathing pattern identification, Flow limitations and posture

[SingleH]

[attachment=55041]

[SingleH]

As I was a bit lost, I then tried the iVaps mode and tried the learn targets on the default settings, but I then realised the pressure was only 6 and the EPAP 4 but I left it running on that for ten minutes just to see what OSCAR would report. Which I have attached below.

           

[SingleH]

   

[SingleH]

I then ran the Learn targets again properly and used the settings from the Titration guide and then let him use it in iVaps for 15mins.

In both iVAPS sessions, the machine did much less of the laboured erratic noises and my fathers breathing was more regular. 

Some screenshots from the second session

           

[SingleH]

In the second session the machine was running really high pressures, as I didn't adjust them and it went up to 25 at one point.

I also noted across all sessions that his respiration rate is a bit more normal now at between 15 to 22.

   

[Sleeprider]

That's a lot of images! For future graphs, substitute the Mask Pressure graph for the Pressure graph. That will let us see much better what is happening with the machine pressure. Also, on the flow rate graph add a dotted line at zero (right click on the y-axis, dotted lines).

I don't know why there is more noise with the Lumis. It should be reaching and holding IPAP and I expect that your dad's airway resists this intermittently based on his treatment with CPAP. In spite of the noise, this looks like good progress. It appears that the mid-inspiration pauses or obstruction have been reduced to flow limits. We now see a peak inspiration with some oscillations. The hypopnea events look obstructive or may be the result of air-packing due to lack of expiration. This is where the lungs are already full and the machine is triggering a breath in ST mode. I though we were going to try S mode and let your dad breath fully spontaneously, so let's correct that. Again if we saw the mask pressure graph we would see the IPAP/EPAP changes. Let's be sure you are in S mode not ST. We may try increasing IPAP by 1 (PS 5). and see if we can clear some of the flow limit. The respiration rate has normalized at 17.6 and the inspiration and expiration times look normal. Tidal volume and Minute vent seems high and we may need to back off of TiMin to 0.5.

[SingleH]

Whether I use the machine or he does it makes a bit of a wailing/whooshing noise on inhalation. However when he used it in S mode it was quite worrying to be honest, really like it was fighting with him.
His breathing sounded and looked very erratic and he just stopped breathing for periods of like 5 seconds his lungs didnt move at all at which point I was a bit worried and switched it from S mode to ST mode mid session and also switched the trigger sensitivity to very high. I appreciate I have confused the matter, but was a bit worried given what I was seeing and hearing. If you see on one of the graphs there is a few periods where there is just no activity and the machine doesn't report this as an apnea or anything. I've not seen this occur when he is on APAP.

I then switched to the iVaps mode the machine sounded far more normal and his breathing was more regular.

I have made a screenshot labelling each session fully zoomed out which may explain what we are looking at on the other previous screenshots. Minute vent and tidal volume is shown in the first screenshot below.

       

This is from the first session in S mode

   

However as the last setting I used was IVAPS mode OSCAR is reporting it was in IVAPS. I noted in ivaps the machine continues to climb in pressure getting higher and higher and ramp was not enabled.

As its now late here I would rather do another S mode test in the day time as not confident to leave it running overnight.

[SingleH]

Long pauses shown below

   

[SingleH]

This was from the last ivaps session after running Learn targets.

iVAPS

Target PT 22
Target VA 7.9L

Auto EPAP Yes
Min EPAP 5
Max EPAP 9
Min PS 4
Max PS 8
TiMax 1.5
TiMin 0.8
Trigger Very High
Cycle Low

       

[SingleH]

Plus, of course, I really did not enjoy the experience of having spontaneous trigger percentages of 50 to 70%.  Almost certainly, what I was really feeling was the effect of the excessive tidal volumes that caused that to happen, rather than the action of mandatory triggering, but either way it was very unpleasant.

Hi Stuart, whilst doing some brief trials this afternoon I noted Spont Trigger at 84% and Spont Cycle at 70%. I wasn't sure if I understood your comment though. Are you saying if you have excessive tidal volumes, a side effect is you wont spontaneously trigger a breath?