Risks using EERS?

[Sleeprider]

The EERS article references the physicians that developed and who routinely prescribe and furnish EERS modifications. I think it's always best to work with your doctor rather than experimenting with solutions that sound good. The EERS is a fairly simple concept, and lends itself to DIY experimentation provided you understand the objectives and respiratory feedback mechanisms at work. If your son has little or no central apnea as diagnosed from sleep tests, but manifests problematic CA when using PAP, then experimenting with rebreathing space is an alternative to options like ASV. Conservative addition of expiratory space either improves the problem or not, and can be fine-tuned based on experimentation. I have no argument with other members advocating doing this in cooperation with the physician.

[SenatorBirch]

NOTE: 

AFTER WRITING UP THE POST BELOW, I NOTICED THE "EXHALATION ELBOW" SHOWN AT THE TOP OF MY DIAGRAM.  THAT CONCERNS ME.  ISN'T THAT PROVIDING A VENT, AND THEREFORE RENDERING MY MODIFICATION IRRELEVANT?

DO I SOMEHOW NEED TO BLOCK THAT OR REPLACE IT WITH A NON-VENTING EQUIVALENT? IF SO, THEN I AM MOVING THE VENT QUITE A LONG WAYS: FROM NEAR THE NOSE, ALONG THE LENGTH OF THE MASK, AND THEN THE 6" OF CORR-A-FLEX. PROBABLY 18 INCHES EXTRA. MORE, CONSIDERING THERE ARE *TWO* AIR PATHWAYS MAKING UP THE MASK FRAME.

OR CONSIDER THIS: WHAT IF DO NOTHING BESIDES PLUGGING THE VENT ON THE NASAL PILLOW.  THAT WOULD EFFECTIVELY MOVE THE VENT FROM NEAR THE NOSE, UP TO THE BACK OF THE HEAD, THUS PROVIDING THE LENGTH OF THE MASK (8" OR SO, TIMES 2, I GUESS) AS EXTRA BREATING SPACE.

I'VE GOTTEN MYSELF A BIT CONFUSED!



Hi again folks.  I'm attaching a pic of how I understand the EERS would be done for the Respironics Dreamwear Nasal Mask.

• The mask vent appears to be that small single hole on the outer side of the "nasal pillow".  So THAT is what I plug with the Mack's Putty?
  
• Having a hard time finding Corr-a-flex, but I found THIS.  It looks like the same thing.  It's 22mm, latex-free, cuts in 6" lengths, and is made by a "Canadian manufacturer of single-use medical devices, focusing on oxygen and aerosol therapy."
  
• So what I'm doing, effectively, is relocating the vent from its position on the mask, to a position about 12" further away (the length of the mask frame tubing plus the extra 6" or so I've provided)
  
• It looks fairy simple - is there anything I'm missing?
  

• So, as per my attached diagram:
  
  
  

1. I plug the vent
   
2. Connect the swivel connection to the Corr-a-flex tubing
   
3. Connect the Corr-a-flex tubing to the Whisper Valve
   
4. Connect the Whisper Valve to the CPAP hose
   
   
   Thanks.
   

   

[Sleeprider]

I'm not familiar with your mask. Just make sure the elbow at the top of the mask does not have a vent. The distance from the nasal interface including mask and sections of flex tube to the whisper vent is your exhale dead-space to accumulate CO2.

[SenatorBirch]

That's the thing though - the "exhalation elbow" DOES have a vent.  It has an array of small holes.

My diagram is not to scale, but I'd bet the air volume of that mask frame is at least as much as the air volume of 6" of Corr-a-flex. (I will measure the volume of the mask when I get a chance)

If I plug the vent on the NOSEPIECE, then I am already creating quite a fairly large deadspace (the whole mask frame).  The advice I've read is to start small (6" Corr-a-flex) and extend if necessary.  Plugging both vents - the nosepiece and the elbow - creates a MUCH larger deadspace.

Does that make sense?


One other question occurs to me: let's assume what I've said makes sense, and I go ahead and just plug the nosepiece vent; do I need to be concerned about the venting capacity of the elbow?  I suppose it's more or less equivalent to the venting of the Whisper Valve.  I could check with Philips I suppose, though I don't know how responsive they'd be to that kind of question.

Thanks