BIPAP Synchrony TM AVAPS

Transcription

1 BIPAP Synchrony TM AVAPS Product Presentation V1.6

2 Contents Home NIV Solution introduction BiPAP Technology and Auto-Trak algorithm Consensus conference, Chest 1999 The AVAPS algorithm The AVAPS settings AVAPS medical benefits Conclusion AVAPS 2

3 Home NIV Needs To provide sensitive triggers To provide high peak flow capability Efficiency To provide patient alarms and monitoring Safety To provide a wide range of modes and settings To provide a minimum ventilation Versatility To follow your patient s ventilation at home Prediction AVAPS 3

4 Efficiency Safety Home Non-Invasive Ventilation Standard Prediction Versatility AVAPS 4

5 Respironics Home Non-Invasive Solution Device BiPAP Synchrony Efficiency Therapy Auto Track Algorithm Bi Level Technology Blower Valve Flow sensor Patient Alarms Safety Patient Monitoring Prediction Versatility Ventilation Modes With AVAPS AVAPS 5

6 Versatility Ventilation Modes With AVAPS AVAPS 6

7 BiPAP ventilation = Leak Ventilation =>Flow Analysis capabilities V tot V leak tot = V est est + AVAPS 7

8 Leak compensation VInspiration = VExpiration No change in baseline VInspiration > VExpiration Adjustment of Vleak for the next breath New Baseline VInspiration < VExpiration New Baseline AVAPS 8

9 Most studies regarding long-term NPPV in patients with neuromuscular disease have used volume rather than pressure targeted devices. More recent reviews have cited the advantages of pressure targeted devices for comfort and their ability to compensate for leaks. Volume targeted equipment may be favorable for many patients simply because triggering mechanism are more adjustable and pressure targeted systems are not able to guarantee a minimum minute ventilation. Source: Consensus Conference Chest 1999: Clinical Indications for Noninvasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to Restrictive Lung Disease, COPD, and Nocturnal Hypoventilation AVAPS 9

10 Average Volume Assured Pressure Support AVAPS automatically adjusts the pressure support level of the patient to provide a consistent tidal volume to the patient AVAPS 10

11 The AVAPS Parameters Available In all the modes of the Synchrony except the CPAP mode: Spontaneous, Spontaneous/Timed, Control, Timed IPAP min IPAP max Target Vte Alarm From EPAP to IPAP max From IPAP min to 30 cmh 2 O From 200ml to 1500ml Low Vte AVAPS 11

12 Suggested Settings for AVAPS Feature To set the target tidal volume to 7-8 ml/kg multiplied by the patient s weight Usual titration process IPAP min = titrated IPAP IPAP max = IPAP min + 4 or 6cmH 2 O or IPAP = titrated IPAP - 3 cmh 2 O IPAP = IPAP min + 3 cmh 2 O ( be careful of high pressures above 20-25cmH 2 O) AVAPS 12

13 AVAPS Algorithm To define the right pressure support to reach the target exhaled tidal volume. For each breath: Estimation of the Vte and measurement of the PS of that breath Calculation of the missing tidal volume = target Vte - estimated Vte Determination of the amount of pressure to add to get the missing tidal volume AVAPS 13

14 Elastance PS of that breath Vte of that breath AVAPS Algorithm For each breath Missing Vte target Vte Vte of that breath PS to add = New PS = missing Vte x Average Elastance PS of that breath + PS to add AVAPS 14

15 AVAPS Algorithm New PS calculation PS PS + P Variation of 1cmH2O maximum every 1 or 2 minutes New PS The patient has a stable ventilation: 1 mn The patient has an unstable ventilation: 2 mn AVAPS 15

16 Example pressure Patient flow Target Vte = 500 ml Measurements: Measured PS = 4 cmh 2 O Estimated Vte = 200 ml Calculation: Missing Vte = 300 ml Pressure to add = (4 / 200) x 300 = 6 cmh 2 O New pressure support = 10 cmh 2 O Next breath: Pressure to add = ( 1 x Tbreath) / 60, If Tbreath = 3s then pressure to add is 0.05 cmh 2 O for a stable respiration and for an unstable breath AVAPS 16

17 Respironics AVAPS benefits The AVAPS function offers the benefits of the Bi Level Technology and the Auto Trak Algorithm Trigger sensitivity High peak flow capability Leak compensation The IPAP changes breath to breath very smoothly Improves the patient s comfort and synchronization Provides the comfort of the pressure modes and the efficiency of the Respironics technology AVAPS 17

18 Respironics AVAPS benefits Increased security: Minimum exhaled tidal volume, exhaled minute ventilation, apnea and disconnection alarms Alarms in case of hypoventilation Average exhaled tidal volume assured Prevents hypoventilation Provides added security functions and an average patient tidal volume AVAPS 18

19 Medical benefits The AVAPS mode provides the pressure support the patient needs to get the target tidal volume: Efficiency Security Comfort Simplify the titration process AVAPS 19

20 Select candidate for AVAPS ventilation Patients who require more security and need a minimum tidal volume/ minute ventilation: Restrictive disorders Progressive restrictive disorders like ALS and Myopathie. Any patients already in pressure support mode who need more security. AVAPS 20

21 Conclusion AVAPS mode: To increase ventilation security To improve ventilation efficiency To help physician to better control the NIV pressure ventilation To come ahead of competition To ventilate more severe restrictive disorders To increase the number of physicians using the Synchrony AVAPS 21