Feeling like I cannot breathe

[vgrando]

I was surprised that she ordered a ventilator. She prescribed that it be set to a Tidal Volume of 400. Mine, while I sleep, varies from 260 to 320 while I am actually asleep even on my Bipap Auto Curve 19 Auto. My weakened diaphragm is the issue, and it will get worse as I age and my Cervical spine continues to deteriorate. However,  I am correct that the trilogy is being discontinued. I cannot afford to buy one of these out of pocket. They run up to $15,000. To get insurance to pay, I would have to have a titration study with a C02 of 52, and I had a C02 of 51. However, I wanted to get an AirCurve11 ASV meant to treat central apneas. My recent titration study showed that I had 60 obstructive, 57 central, and 21 mixed apneas. Having 50% cental/complex apneas or more should qualify for one for Medicare. But I can afford to pay for one out of pocket. They just came out with the AirCurve11 ASV, which is more streamlined and lighter.  

Do you know if AirCurve11 ASV would help with Tidal volume?

Thank you for all your help!

[Sleeprider]

The ASV is not recommended for hypoventilation because it establishes the volume and rate targets from the last 90 second average respiration, and there is no setting to over-ride that automatic target. As a result, the use of the Resmed ASV in hypoventilation patients is not recommended because volumes can fall below the recommended rate. The Resmed Aircurve ST-A has an iVAPS algorithm that is intended to resolve both volume and rate issues with an adaptive pressure support. Quite a bit harder to set up this machine. You can read about both of these devices and their intended use in the Resmed Sleep Lab Titration guide https://www.resmed.com/us/dam/documents/...er_eng.pdf

[SarcasticDave94]

I'm not indicating I'd be much help in suggesting settings on either Astral or ST-A, however I think ST-A may be both easier to afford and setup. I have borrowed an ST-A for about a month a few years ago, and I was able to get decent setup in a few days. Pressure mostly similar to what I was running in ASV and then edits to backup breath rate. Then I started to expand timing Max a bit. Again only what I did for myself.

I think I have the ST-A and Astral clinical manuals with Astral having more to digest.

Edit... Even though V in ASV is ventilator, it's still in the CPAP class, because its ventilaton action is just blowing hard to induce a breath during CA. It will not really assist in breathing like true ventilators, nor are there any timing controls on ASV. So any breath time issue will not be addressed.

[vgrando]

Thank you both! I agree.

My concern is that for years, I have had documented atelectasis of the lower lungs without a documented cause for several years now. I never have had pneumonia. The MDs seem to ignore this even though my diaphragm, which is elevated on the right side, and my scoliosis restrict my breathing while at rest and at sleep.

I think that my neuromuscular issues will get worse as I age, which will lead to increased respiratory issues. Hopefully, having ventilation support while I sleep will help.

[SarcasticDave94]

Understood. In that case, I'm inclined to think true ventilator class like ResMed Astral 100 or 150 will be your best bet. If Philips Respironics is still an option, (saying so due to the ban of other machines in the US) there's the Trilogy and Trilogy Evo models.

Note from my experience in general and info from my Lincare RT about machines. If you're used to Philips Respironics it may be the better feeling, and vice versa with ResMed. Apparently there's a perceptive specific "feel" that will be familiar or foreign to you, either aiding or hindering successful beginning with vents.