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Enhanced Expiratory Rebreathing Space (EERS) may be a solution for individuals that experience therapy onset central apnea with CPAP or bilevel therapy. The rebreathing space prevents all of the exhaled air from being vented through the CPAP mask. This increases the amount of carbon dioxide that the user breathes in in the next breath. CPAP and Bilevel therapy flush most of the user's expired air out of the mask. For some sensitive individuals this decreases the amount of carbon dioxide which leads to the appearance of central apnea. Many of these individuals find that CPAP/BPAP therapy is uncomfortable due to the central apnea and hypopnea that they experience. EERS can ensure a volume of expired air is available for rebreathing, and this can prevent these therapy onset central apnea, or [http://www.apneaboard.com/wiki/index.php/Treatment-Emergent_Central_Apnea Treatment Emergent Central Apnea ].
EERS is a potentially useful therapy for positive pressure CPAP and BPAP associated respiratory instability and CPAP treatment failures. Individuals that experience therapy onset central apnea seem to be particularly likely to benefit from EERS. Some patients experience hypocapnea,a state of reduced carbon dioxide in the blood. The theory is that the use of positive air pressure, especially with pressure support (PS) or exhale pressure relief (EPR) can result in a drop in carbon dioxide in the blood, which through various respiratory feedback mechanisms can result in the emergence of central apnea (CA). By adding dead-spece space or a larger volume of re-breathed air, the normal carbon dioxide balance can be restored, and thereby prevent the side effect of central apnea in these individuals.
EERS is accomplished by blocking the mask exhaust ventsusing Mack's Silicone Putty (earplugs), and adding a length of tubing to the mask that terminates in a mask exhaust vent. For safety purposes an antiasphyxiation/saftey safety valve is included in EERS for full-face mask setups to ensure continued airflow in the patient circuit in the event of CPAP failure. This safety valve can be omitted in nasal therapy. EERS creates a larger dead-space by moving the mask vent to a position further down the tubing toward the xPAP machine.
== Fabrication of EERS ==
EERS can be added to nasal or full face mask interfaces. At his time there is no commercial or retail availability of the EERS circuit and they must be custom bilt built by the user or a few knowledgeable durable medical providers or doctors. This section describes a simple method of constructing EERS using available Corr-A-Flex CPAP tubing, a mask vent / swivel and an optional antiasphixiation safety valve. To find these items for a DIY, search on Ebay , Amazon or similar site for:
* Respironics Whisper Swivel II
* Fisher & Paykel Oracle 452 Flexitube Kit (includes the safety valve, which I couldn't find on its own)
* Hudson RCI CORR-A-FLEX Corrugated Tubing 72 in
* Mack's Silicone Putty Earplugs
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