Can someone help me with these flow rates?

[emredogan]

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[emos12]

Hello Its me again,

So I think that I have a pressure that has a consistent effect on my flow limitation. With this I mean that the flow limitations are all tackled. The shapes of my flow rate's look very different though, which isn't all that strange with a pressure of 16. I was wondering if these flow rates are still limited and if I need to bump up the IPAP. Anyone some advice?

Thanks !

[Sleeprider]

At PS 4.0 (16/12), your inspiration is still very flow limited. I think you might try 17/12 and see if a bit more pressure support helps move those inspiration waveforms towards a more normal curve.

[emos12]

Hee Sleeprider,

Thank you I after a week of trialling this pressure I think it is indeed good to increase the pressure.

Tonight I will set it up at IPAP: 17 EPAP 12. One thing I do not understand is why I should only increase my IPAP as I feel like the inspiratory effort will be lightened by a higher EPAP or is this not true?

Thanks!

[Sleeprider]

It is the difference between EPAP and IPAP that makes inspiration easier. We only increase EPAP until obstructive apnea is mostly resolved, then we focus on IPAP or pressure support to increase ventilation volume and relieve flow limitation.

It looks like you may actually be able to reduce EPAP pressure a bit. On your next graphs, please minimize the monthly calendar by clicking the triangle in date line.

[emos12]

The higher pressures were making me sleep very uncomfortable, could not adjust to the high ventilation. So I used the approach sleeprider suggested, using a pressure support of 5 at a lower pressure: EPAP:7 and IPAP: 12. I slept pretty well without waking up however I still have long periods of the flow limit events, they are attached. Still my sleep feels like crap waking up gasping for air and out of breath.

These periods last up to 30 minutes and I was wondering if I should increase the pressure.

last picture is what most of the night looks like what I imagine is normal breathing

thanks

[Sleeprider]

It’s good to hear that comfort has increased. FL is still significant and I would stick with the strategy of increasing PS rather than pressure. Just keep increasing IPAP in small increments to break the restriction.