[split] Mal777 Lumis 150 ST-A iVAPS Therapy

[Mal777]

I have just received my Lumis 150 ST-A (IVAPS) for a 4 week hire, with the option to buy if I find the machine suitable. Unfortunaely my sleep physician looked at me with a blank face when I mentioned the ST-A, and had no idea about IVAPS set up.  The young girl at the cpap shop was very nice, but unfortunately also had no idea about setup . So I am in desperate need of help.... 
I was running my old Aisense 10 auto at 10-15, with severe flow limitation, and erratic RR, as was shown in all the previous posts. Sleep study recommended ST, but on the valuable advice of Sleeprider and others, managed to get script for ST-A
I have enclosed a couple of screenshots and my sleep study again, and there are many other screenshots of my Oscar data in previous posts.

These are the settings I am faced with on the new machine  (daunting!), and the  values currently entered (a couple  by me, some default))

Target PT rate (currently 15)
Target Va (currently 5.22L/Min)
MV (7.1L min)   (greyed out)
VT 474 ml    (greyed out)
Vt/kg 6.4/KG   (greyed out)
Auto Epap    Off
Epap 4.0
Min PS   2
Max PS  20.0
Ti max  2.0s
Ti Min 0.7
Rise time 300ms
Trigger    High
Cycle   Low

Help would be greatly appreciated. 


As well as sleep study have also included a couple of recent screenshots of my data

thanks so much

Mal

PS And maybe this should be moved to a new thread?  called something like  "Help with setting up my Lumis 150 ST-A (IVAPS) "

[Geer1]

If you Google resmed titration guide can find document with recommended titration procedure.

Target pt rate is based off spontaneous respiration rate which you can get from previous OSCAR data.

Target Va is the minimum ventilation rate you want the machine to work to maintain. There is a calculation. Based on height but you can also go off minute ventilation and tidal volumes in OSCAR data. Probably start a little low and then increase if/as needed.

I'd set EPAP a bit lower than what you previously needed. I see auto is an option so can turn that on and it will adjust.

Machine will provide PS as required to maintain the target Va. Starting with psmin of 2 will probably be good to start with considering different pressure waveform.

Ti and trigger/cycle probably decent for now, can fine tune as you learn more about them.

Rise time you probably want to increase to at least 600 ms. You will note that the breath waveform is a lot more square shaped. The longer rise time will make it more triangular like easybreath waveform.

I'm sure others might have other comments.

[Sleeprider]

Hi Mal777. I like your settings with some minor changes. First, I think you may need higher PS min to more affirmatively guide your respiratory rate and fight hypopnea, so I'll suggest you use 4.0 for that setting. I'm going to recommend a Ti Min of 1.0 in order to ensure you do not cycle out prematurely. and based on the experience with Plmnb, I think a rise time of 500 will be more comfortable, and we may eventually go longer. I was not aware your machine offered auto EPAP, and if that is in fact available, we might want to use it. If you enable Auto EPAP, does that then add settings for EPAP min and EPAP max?

The target Va looks conservative, and I think Vm and Vt will automatically calculate. Vt appears to be at 474 mL which seems appropriate based on past results. I'll leave this image of the recommended iVAPS titration protocol for discussion and consideration:

[Mal777]

Thanks Geer 1 and Sleprider. I will certainly restudy the Resmed titration guide, although it is all somewhat confusing

Sleeprider, 
You asked if enabling  Auto EPAP,  adds settings for EPAP min and EPAP max? Yes it does...
What settings would you suggest I try for min and max? ?  (my old Airsence was 10-15)

Geer 1,
I'm having difficulty getting my target VA. Changing my height makes no diffrence to current reading of 5.22L/min  .   My tidal volume median over past 6 months is 520.0, and my median Minute Ventilation is 9.0. I'm not sure how I can adjust my target VA from these figures ?

thx, Mal

[Sleeprider]

Mal, the auto EPAP is intended to automatically raise EPAP pressure if obstruction is encountered. The defaults for the ASV are 4.0 minimum and 15.0 maximum. I think just plug those in with Auto EPAP on and we will see what happens, and fine-tune later.

[Geer1]

Mal yes you can just use an open range for EPAP (4-15) and we can see what happens. EPAP settings are less important with the ST-A(because of varying PS and backup rate) so we can start a bit lower. It will be interesting to see how this machines EPAP reacts, other users I have looked at data for have only had it in fixed EPAP mode.

On the note of PS I see Sleeprider was thinking starting at 4, I think you should use 3 at most to start with, the machine will increase it as needed to maintain ventilation. The ST-A square shape waveform provides significantly higher inspiratory pressure support, the work being done by the machine is the area under the pressure curve which if using a fast rise time (300 ms) is probably around double the work and a rise time of 500-600 is probably 1.5 times. I was just guessing that a PS of 2 with this waveform would be close to the EPR of 3 on autoset, PS of 3 will already be a significant step up from autoset.

I'm not sure exactly how the height setting adjusts things but I thought it did have an affect. Maybe there is another screen for calculating target Va? I know there is a learning mode but I wouldn't use it as it too easily gives bad results. Once your target is set you are able to manually override it, doing so until the minute volume and tidal volumes are in the range you would like is probably best.

One thing you need to be careful/aware of is that all your statistics are too affected by your periods of strange respiration. You cannot rely on calculated median statistics (6 month etc) due to your unique breathing periods. What you need to do is flick through your data looking for periods of good consistent breathing and manually collect some data points from those periods and then calculate a rough average value to use as your baseline, try to look at a few different days to see if the values are consistent. To try and explain this better see the attached example of one of your nights, the red circled area is a moment of good consistent respiration that you should be using for calculations, you can see how you respiration rate, tidal volume etc numbers are out of whack during the other strange breathing periods.

   

[Gideon]

I think you will find that EPR of 3 acts the same as a PS of 3 when EPAP pressure is the same on both machines. Personally I'd start with the PS = 4 that Sleeprider suggested.

[Sleeprider]

Thanks Bonjour. I also stick with my original suggestions until we see something to the contrary.

As you can see, we split this into its own thread, and the Cheyne Stokes Respiration thread is still available for reference here http://www.apneaboard.com/forums/Thread-...ion--27308

[SarcasticDave94]

Not trying to muddy the waters, but is the Lumis ST-A 150 the same as our US AirCurve ST-A? If a yes, some of those set-up aspects for target Vt (maybe), it should have a Learn test thing to enable as in like what Plmnb possibly did with hers. Don't know if that helps to gain progress through the titration giude.

PS yep it does an auto-learn...looking at a PDF now to see what I can glean...

[Mal777]

Thanks for splitting the thread Sleeprider. For anyone interested in reading the previous post, with data from my old Airsence 10, the link is here

http://www.apneaboard.com/forums/Thread-...#pid337138