The case against EPR?

[Narcil]

Came across this talk by Dr David White ex-chief medical officer of Philips Respironics, not a great look i know.. besides his new algorithm that could improve comfort without increasing AHI (called kpap) i think the more interesting part or the presentation was the data against c-flex and EPR.

I'll include some screengrabs but the tldr is lower epap significantly reduces pharyngeal cross-section and doing the opposite (EPAP > IPAP) seems more beneficial. because when you inhale if your mask pressure is 10cm your pharyngeal pressure is around 7cm, while the opposite is true on exhale, if your mask is at 10 your pharyngeal pressure is above that this dilating your airway more.

He also says that EPR should almost always if not always be turned off if you encounter treatment emergent CSA and presents data to illustrate it. he also talks about vcom the device that currently accomplishes this epap > ipap. 

any thoughts? plausible or just some biased quack trying to peddle his algorithm?

https://www.youtube.com/watch?v=epXcTkchLXY

[Sleeprider]

And that is why Philips is essentially out of business in the U.S and Resmed has record market share. My opinion on this is well documented from long before Philips ever screwed the pooch. EPR is a bilevel algorithm that has repeatedly demonstrated efficacy in reducing flow limitation, RERA and hypopnea, and is coupled with an algorithm for pressure that proactively prevents obstructive sleep apnea. All of this is superior to any Philips Auto CPAP or BiPAP algorithm. The consistency of the results has resulted in Philips being regarded as a joke. We all know that it is PS that avoids flow limitation, so the argument that decreasing EPAP, increases flow limitation is a red-herring argument. The chart shows 11/8, 11/9, 11/10 and 11/11 (CPAP which results in increased flow flattening as pressure support decreases. What's new? Not only is the airflow best with higher PS, the graphs shows the square-wave Philips pressure application sucks compared to the EasyBreath™ algorithm used by Resmed. Philips is determined to continue to foist uncomfortable and ineffective therapy on patients. JMHO I Have to add, that this joker needs to go his inferior BiPAP device to try to show EPR is not effective, rather than showing the thousands of examples we have seen on Apnea Board that shows how EPR actually helps improve flow limitation, efficacy and comfort. My take-away is that this proves how terrible the Philips algorithms are in comparison.

[PeaceLoveAndPizza]

Interesting. It will take time to work through it all as his voice makes me want to have a kip.

An important lesson in life is when you go to a surgeon for advise, never be surprised when the answer involves surgery. Likewise, when you go to a company producing a product for advise, never be surprised when the answer involves their products.

Whether it is the bees knees or another barmy idea will play out in its own time. I would not get excited about a miracle just yet.

[Sleeprider]

Until Philips acknowledges the serious deficiencies in it's therapy algorithms, it will never be a contender in the market.

[Nightynite]

I learned my lesson with the V com. Boy, did I drank that Kool aid.

[MrIvanDrago]

I watched this presentation live and did not catch that he previously worked for Phillips. The KPAP algorithm they developed is similar to the VCOM, which I tried before BiPAP and it made me feel like I was suffocating. They are trying to get this KPAP algorithm as an option on all machines. Maybe it will work for some folks, but I did ask the question about those with flow limits and RERA's, it was not answered.

The amount of success criteria they will need for any of this to become a reality is immense, especially in the US with all the regulations involved.

[Narcil]

yeah i don't really get excited about new algorithm, seems a new one pops up every week. i'll get excited when it's on my machine.

the interesting part was the data against lowering epap. the last graph is the head scratcher for me, it clearly says at the top "Decreasing EPAP increase flow limitation" which is the opposite of what i thought.

this is the study he is referencing: https://journals.physiology.org/doi/full....85.5.1855

Our results suggest that increasing the Pi-Pedifference (i.e., decreasing Pe) may be associated with a significant worsening in inspiratory flow limitation

[SarcasticDave94]

It's almost akin to static CPAP and no EPR because the medical moonlighter says it's bad. Backstory is they want to to be dependent on them to edit settings, generating recurring visits, payments, and possibly sneaking in more testing so they can get it "right".

This new Philips Respironics tech is called KRAP it seems.