BIPAP Synchrony TM AVAPS

(1)

V1.6

BIPAP

®

Synchrony

TM

AVAPS

Product Presentation

(2)

Contents

¾

Home NIV Solution introduction

¾

BiPAP Technology and Auto-Trak algorithm

¾

Consensus conference, Chest 1999

¾

The AVAPS algorithm

¾

The AVAPS settings

¾

AVAPS medical benefits

(3)

AVAPS 3

Home NIV Needs

Efficiency

To provide sensitive triggers

To provide sensitive triggers

To provide high peak flow capability

To provide patient alarms and

monitoring

Safety

monitoring

To provide a wide range of modes

and settings

To provide a minimum ventilation

Versatility

To provide a minimum ventilation

Prediction

To follow your patient’s ventilation

To follow your patient’s ventilation

at home

(4)

Home Non

-

Invasive Ventilation

Standard

Efficiency

Safety

(5)

AVAPS 5

Respironics Home Non

-

Invasive Solution

Prediction

Safety

Patient Alarms Patient Monitoring

Versatility

Ventilation Modes

With AVAPS

AVAPS

Efficiency

Device BiPAP Synchrony Auto Track Algorithm Bi Level Technology Blower Valve Flow sensor Therapy

(6)

Versatility

(7)

AVAPS 7

BiPAP

ventilation = Leak Ventilation

=>Flow Analysis capabilities

V

V_tot_tot = V= V_est_est + + V

(8)

Leak compensation

Adjustment of Vleak for the next breath

New

Baseline

New

Baseline

V

Inspiration

<

V

Expiration

V

Inspiration

>

V

Expiration

V

Inspiration

=

V

Expiration

No change

in baseline

(9)

AVAPS 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”

(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

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AVAPS 11

The AVAPS Parameters

¾

Available In all the modes of the Synchrony except the CPAP

mode: Spontaneous, Spontaneous/Timed, Control, Timed

IPAP min

From EPAP to IPAP max

IPAP max

From IPAP min to 30 cmH

2

O

Target Vte

From 200ml to 1500ml

(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 6cmH₂O

IPAP = titrated IPAP - 3 cmH₂O IPAP = IPAP min + 3 cmH₂O

(13)

AVAPS 13

AVAPS Algorithm

To define the right pressure support to

reach the target exhaled tidal volume

.

¾

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

(14)

AVAPS Algorithm

Missing Vte

target Vte –Vte of that breath

Elastance

Vte of that breath

PS of that breath

For each breath

PS to add = missing Vte x Average Elastance

New PS =

PS of that breath + PS to add

(15)

AVAPS 15

AVAPS Algorithm

New PS Variation of 1cmH2O maximum

every 1 or 2 minutes

PS PS + ∆P New PS

calculation

The patient has a stable ventilation: 1 mn

(16)

Example

¾ Target Vte = 500 ml pressure Patient flow ¾ Next breath:

‐ Pressure to add = ( 1 x Tbreath) / 60, If Tbreath = 3s then

¾ Measurements: ‐ Measured PS = 4 cmH₂O ‐ Estimated Vte = 200 ml ¾ Calculation: ‐ Missing Vte = 300 ml ‐ Pressure to add = (4 / 200) x 300 = 6 cmH₂O

(17)

AVAPS 17

Respironics AVAPS benefits

¾ The AVAPS function offers the benefits of the Bi Level Technology and the Auto Trak Algorithm

‐ Trigger sensitivity

‐ High peak flow capability

‐ Leak compensation

¾ 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

(18)

Respironics AVAPS benefits

¾

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

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AVAPS 19

Medical benefits

¾

The AVAPS mode provides the pressure support

the patient needs to get the target tidal volume:

‐

Efficiency

‐

Security

‐

Comfort

(20)

Select candidate for AVAPS

ventilation

¾

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

(21)

AVAPS 21

Conclusion

¾ 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