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+--- Thread: Need help with Philips Respironics BiPAP AVAPS (/Thread-Need-help-with-Philips-Respironics-BiPAP-AVAPS)
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-06-2018
Well the s/t mode did not go well on a test run with the PR machine. Breaths were getting cut off and were often out of sync. I guess the next move would be to stay in PC mode and try a slightly faster inspiratory time like .9 seconds instead of 1 second. That trend did seem to be panning out...
I was indeed doing a Ti min of .8 seconds on the ResMed, with a Ti max of 2.0 seconds just in case. However, once I fell asleep, my Ti was pretty much always below 1 second so maybe indeed that is just how I breathe...fast and shallow.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-07-2018
For fun I whipped out the ResMed and threw it in iVAPS mode. I used Ti min .8 seconds, Ti max 2.0 seconds, Rise time of 5 so that the pressure wouldn't bother me. I was able to spontaneously trigger 100% of breaths, and cycle 73% of breaths on my own. The median Ti showed as .9 seconds, so I indeed do just breathe faster when I sleep. I am going to increase the target Va, and then up the PS min as indicated by the data, and see if I can get the natural Ti to increase, and hopefully the respiratory rate to decrease as well, while the Mv and Vt increase. That is the hope anyway!
RE: Need help with Philips Respironics BiPAP AVAPS - Sleeprider - 11-07-2018
Looking forward to hearing how that works out. Keep us posted.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-07-2018
Thanks. It's hard to find people online using AVAPS or iVAPS, and in the real world a lot of the doctors I've met don't have any idea either.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-08-2018
I tried out last night the follow settings and the results were okay, but an improvement from the baseline.
Height: 155cm
Target Va: 4.0 L/min
Target Patient Rate: 15bpm
EPAP: 5.0
PS Min: 5
PS Max: 20
I ended up with a Vt of 280, Median RR of 21 and 95% of 23, Mv of 6.0 and a median IPAP of 16. I am going to keep the same target Va tonight, but bump the PS Min from 5 to 9, so that the min IPAP will be 14 instead of 10. I am hoping to bring down the RR and reduce any pressure swings, before I experiment with bumping the target Va up any further.
RE: Need help with Philips Respironics BiPAP AVAPS - Sleeprider - 11-08-2018
Here is hoping you find comfort. I think you are on the right track to optimize iVAPS. We are both in learning mode.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-09-2018
Last night's settings seem to have gotten me basically the same results. The median IPAP went down to about 15, but the 95% increased to 22 instead of 20 something. I had a few short spikes to IPAP 25 as well, but the swings did seem less overall than the previous night. I didn't sleep very well though and woke up a few times, but I am not exactly sure for the reason because that is pretty typical. Of course no one sleeps the same each night.
Tonight I am going to just increase the PS Min to 12 and raise the Ti Min to 1.0 seconds because I notice that my inhale:exhale ratio is greater than 1:2.5 median wise, and I think I need a slightly longer inhalation to improve that, especially considering I have a restrictive lung disease.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-10-2018
Last night with PS Min of 12, PS Max of 20, and Ti Min of 1.0 seconds, the Vt increased to 300ml and median respiratory rate reduced to 20bpm. This was after going out and having 1.5-2 drinks as well and being very tired, so I don't remember waking up much throughout the night. The Ti Min 1.0 second helped to improve the I:E ratio to just about 1:2 which for me as a restrictive lung disease patient I think is a good thing. Tonight I am going to leave the Ti Min 1.0 seconds alone and raise the PS Min to 13. My goal is to get the Vt closer to 400ml to make sure that I'm getting enough volume and blowing off the CO2.
RE: Need help with Philips Respironics BiPAP AVAPS - Matt00926 - 11-13-2018
Well iVAPS has kind of been a failure. With ResMed there seems to be too many settings aside from pressure, and they are not playing well together.
I have the opportunity to do an AVAPS titration in the lab so I think I am going to do that.
RE: Need help with Philips Respironics BiPAP AVAPS - Sleeprider - 11-13-2018
I think it was a good effort. Your logic was good, but you are faced with a complex set of health problems. I think the AVAPS titration is a great idea, but be sure that the study plan includes your objectives for therapy. Hopefully your doctor is open to discussing the strategy and plan ahead of the test.