Need reviews on report

[Moin Pathan]

kindly go through and suggest anything about the report.

[Sleeprider]

Welcome to Apnea Board. Your report from the Lumis 150 iVAPS shows you are getting excellent therapeutic results with zero AHI at EPAP min 6.0, EPAP max 8.0 and PS at 9.0 to 15.0. This will yield a pressure range of 15/6 to 23/8 (IPAP/EPAP). Results suggest you use this entire range, but rarely hit the IPAP max. The charts show the target vent rates are consistently met and tidal volume and respiration rate is in the normal range. The machine seems to be doing most of the work with a low spontaneous trigger and cycle rate, but your AHI is effectively zero with all targets being met. You appear to have good use every day with long sleep session and a short nap daily.

This kind of machine is normally reserved for individuals with a high level of need for pulmonary support, and it appears to be working well based on the data. If you want to discuss comfort or use issues, we can try to help.

[Moin Pathan]

thanks a lot for the review. i am totally unaware of numbers and definitions. what is trigger breathe, what is spontaneous breathe, everything. i am bringing out reports every after 15 days and just storing it. I can't judge anything about health condition from reports. AHI is zero and i don't know is it good or bad.
thanks.

[Sleeprider]

Many of these definitions are in our Wiki here: http://www.apneaboard.com/wiki/index.php/Definitions

Your AHI is excellent, but he machine is causing (triggering) most of the breaths. Your airway is open (not obstructed) and the machine is detecting a lack of spontaneous effort (voluntary breathing triggered by the nervous system and caused by muscular effort), and is causing you to take the necessary breaths by providing pressure support sufficient to cause air to flow into your lungs. Your machine has settings that ensure your ventilation volume in liters per minute is met using pressure support. So you are receiving a combination of spontaneous (breaths you take), assisted (breaths you start but are supplemented by pressure support), and triggered (automatic switching to IPAP and filling your lungs).

We don't know the reason you need this advanced ventilation support, but it is working well, and your health should be protected as a result.

[Moin Pathan]

I am glad to have such wonderful and detailed reply from you. Actually this is my father's report. He has muscle dystrophy ( mostly limb girdle muscular dystrophy because no doctor have came out from exact conclusion wheather it's limb girdle or beker ) and due to that his lungs have gone almost 80%. he can't breathe out co2 properly and that affects his overall health now with this machine, he is passing his life, however doctor's have already declared that in such decease there is no guarantee how long the patient will survive. i am mentally prepared that my father will pass out suddenly one day may be in his sleep too.

[Sleeprider]

It's certainly difficult to see our parents suffer the end stages of debilitating disease and old age. Your dad has very good doctors, and he has exactly the therapy he needs from what I can see here, and his response is exactly what the machine is designed for. We too often see people treated with the wrong device, but this is truly exceptional. It does not tell us what his blood oxygen saturation is, but the tidal volume and minute vents appear normal. Using a recording oximeter to confirm SpO2 would be a good idea to determine if supplemental oxygen should be added to therapy; otherwise, this looks excellent from what we see.

[Moin Pathan]

Spo2 mostly stays around 95 and beats around 68. I don't know what to do next. Should i increase Ipap and epap settings? Will it damage to lungs if i increase IPap and epap settings?
Thanks.

[Sleeprider]

A median SpO2 of 95% is normal and healthy, however we look at minimums and their duration. If levels fall below 80 we are concerned, and would like to mitigate that. I believe the U.S. Medicare threshold for oxygen therapy is an oxygen nadir at or below 88% for more than five minutes. Normally, a non-invasive ventilator will not provide sufficient efficacy in ensuring SpO2 remains at an effective level. While that machine clearly helps to maintain the breathing rate and volume, oxygen desaturation would be corrected by supplying supplemental oxygen to an oxygen bleed adapter from an oxygen concentrator. We have a wiki article describing how that is done http://www.apneaboard.com/wiki/index.php..._with_CPAP

If your dad uses supplemental oxygen during the day, it is a simple matter of attaching the oxygen tube to the CPAP tube instead of a canula, and adjusting the oxygen feed to account for dilution of the CPAP air. If he does not use oxygen, It is probably a good idea to have his levels evaluated using a medical grade recording oximeter and working with a physician to order appropriate therapy. The iVAPS machine he is using is a very high level of positive pressure therapy that appears to be delivering appropriate volumes of air to his lungs;, but may not be a complete solution for his condition. With some individuals a higher level of oxygen is needed to assist an impaired exchange of oxygen across the aveolar membrane to the pulmonary system.

[Moin Pathan]

he is using oxygen with cpap machine. before six months doctor informed us that there will be a time when he will not be able to manage breathing and due to high Co2 level, he will die or will be in coma permanently. I want to know, if i increase Epap and Ipap settings towards higher number, does it going to make any difference ? will it be more beneficiary? and higher pressure will leads to lungs damage ?
thanks.

[Sleeprider]

I can only relate to your basic principles of mechanical ventilation and oxygen supplementation which you can find yourself online:

1. Oxygenation is enhanced by "Positive End Expiratory Pressure PEEP" which improves the transfer of oxygen in the lungs. PEEP is the same as EPAP min.
2. Oxygenation is also improved by increasing the concentration or "fraction of inspired oxygen" in respired air (FiO2). The Oxygen Bleed wiki discusses the calculation of FiO2 at different PAP pressures to account for dilution.
3. Ventilation and exchange of CO2 to reduce hypercapnea is enhanced by greater pressure support (greater difference between IPAP and EPAP. This is sometimes tricky because excess ventilation or hyperventilation can result in hypocapnea. In addition, in non-invasive ventilation you rely on adaptive pressure support to facilitate or trigger inspiration. On the iVAPS the doctor has set the target volume, and it appears to be met.

In no way am I recommending that you employ any of these ventilation strategies without the guidance of a medical doctor, however these basic principles contain enough terms for you to research how they work to solve the problems you raised.