All About Positive Airway Pressure (PAP) Therapy
|
|
- Annis Holmes
- 5 years ago
- Views:
Transcription
1 All About Positive Airway Pressure (PAP) Therapy Nitipatana Chierakul Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Medical School
2 Siriraj Sleep Center: Fiscal-year 2018 Profiles Activity Number PSG 1,620 New PAP 1,062 MPAP 625 (14) APAP 427 BiPAP 10 (7) Accessory 1,546 Mask 468 Humidifier 55 Daytime visit 15,954
3 Positive Airway Pressure (PAP) Continuous PAP (CPAP) is standard therapy for patients with OSA Deliver positive pressure to the upper airway via interfaces, serving as a pneumatic splint to prevent collapse during sleep After invented for nearly 40 years, newer generation can recognize and differentiate SDB events, ramp, adjust counter balance output, monitor usage, communicate, and slim (0.5 vs 7 kg)
4 Autotitrating CPAP (APAP) Continuous pressure self-adjustment based on analysis of flow amplitude reductions, inspiratory flow limitation, (snoring, cardiac artifacts, forced oscillation for OSA vs CSA) Contraindicated in Congestive heart failure Other respiratory diseases especially COPD Daytime hypoxemia/hypercapnia Other causes of especially OHS Central sleep apnea Provide lower mean airway pressure but potentially higher peak airway pressure as compared to fixed CPAP, proper mask fitting is crucial
5 APAP Certain APAP devices (display 95 th percentile pressure, leaks, AHI, and store > 1 night data) may be used to determine a fixed CPAP pressure for patients with moderate to severe OSA without contraindications Those being treated with fixed CPAP on the basis of APAP titration or being treated with APAP, must have close clinical follow-up to determine treatment effectiveness and safety Reevaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy
6 Phenotypic APAP Respond faster and fine tune to small flow limitation in female Detection of expiratory puffs (oral venting) Autotrial mode for transition to fixed pressure Automatic pressure adjustment (CPAP check) Expiratory relief to compensate discomfort from exhalation at higher lung volume Lowering pressure in periods of irregular breathing associated wakefulness
7 PAP Interface Proper fitting and comfortable also determines compliance Consider: facial size and shape, hairstyle, nasal figure, claustrophobia, tendency for mouth breathing, cranial deformity Plastic material and silicone components Smaller interface Less obtrusive headgear Expiratory noise reduction Limited parts for cleaning and servicing
8 PAP Humidification Dry air can lead to mucosal burning/ congestion, nasal dripping and slippage Integrated humidifier instead of in-line, external humidifier Self adjustable level of humidity and ambient humidity sensor Heated tubing minimizes the temperature drop and condensation Smaller water storage is a limitation for higher humidity need In-line heat and moisture exchanger (HME)
9 PAP Compliance Systematic educational programs are recommended to improve utilization Usage should be monitored subjectively and objectively Transfer large sets of data (compliance, leak, AHI) manually or online/cloudbased Initial follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems
10 Strategy for Enhancing PAP Use Systematic education about health consequences of OSA Fit and comfort interface Aggressive nasal congestion treatment Humidifier or heated humidifier Frequent contact and followup initially Spouse involvement Immediate intervention for side-effects or discomforts
11 Handle Adverse Effects of PAP Adverse effects Dry nose/mouth Nasal congestion Bruise Aerophagia Difficult exhale Management Reassure Intra nasal steroid Heated humidification Protective padding Different interfaces Reassure, antacids Interface Different machines
12 Residual Sleepiness after Adequate PAP Use Suboptimal pressure Suboptimal treatment adherence Insufficient sleep time Presence of other sleep disorders Drugs or substances use and abuse Permanent hypoxic damage of brain areas involved in alertness Somnogenic cytokines released from visceral adipose tissue Adjunctive modafinil in those without obvious causes
13 How PAP works in CSA Raising lung volume, thereby increasing lung O 2 reservoir and thus dampening fluctuations in PaO 2 Reducing lung water and thus pulmonary irritant receptor stimulation Reducing ventilation and allowing PaCO 2 to rise above the apnea threshold Increases left ventricular ejection fraction, reduces mitral regurgitation, and decreases sympathetic nervous system activity Trial of CPAP may be given for CSA-CSB, should be stopped if AHI remains > 15 because potential harm
14 Adaptive Servoventilation (ASV) PAP specifically designed to alleviate CSA-CSB analogous to a cardiac pacemaker When central apnea is detected, it provides intermittent PSV But when it detects spontaneous breath, inspiratory assist is turned off In patients with CHF and CSA-CSB, it causes a greater fall in the AHI than CPAP, BiPAP, or supplemental O 2 Increased mortality in HFrEF (< 45%) may result from outdated machine
15 OSA Treatment options for CSA CSA CSA n heart failure Idiopathic periodic respiration Opioidinduced sleep apnea Stroke, renal failure, other comorbidities Optimal cardiac treatment CPAP Reduction/ withdrawal of opioids? Optimal therapy of underlying disease LVEF < 45% LVEFR > 45% Persistent CSA AHI > 15 AHI <15 Persistent CSA AHI > 15 AHI <15 Persistent CSA AHI > 15 AHI <15 Predominant OSA Predominant CSA Persistent CSA AHI >15 ASV CPAP CPAP CPAP Severe symptoms Minor symptoms CPAP Persistent CSA AHI > 15 AHI <15 Persistent CSA AHI AHI <15 Persistent CSA AHI >15 AHI <15 CPAP Continuing heart failure therapy Persistent CSA AHI >15 ASV ASV ASV ASV Eur Resp J 2017; 49:
16 Practice Parameters for the Use of CPAP and BPAP Devices to Treat Adult Patients with Sleep-Related Breathing Disorders (AASM 2006) While the literature mainly supports CPAP therapy, BiPAP is an optional therapy in some cases where high pressure is needed and the patient experiences difficulty exhaling against a fixed pressure or coexisting central hypoventilation is present (Guideline) BiPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with daytime hypercapnia (Option)
17 Pressure Pressure-Time Waveform of BiPAP IPAP EPAP Trigger Inspiratory Time Rise time Cycle Vt EPAP/IPAP: end-expiratory/inspiratory PAP Trigger: switch from EPAP to IPAP Rise time: transition from initial to peak inspiratory pressure Inspiratory time: time spends in IPAP Cycle: switch from IPAP to EPAP Time T mode: time-triggered or mandatory breath, initiated by the device based on preset backup RR p T S T S mode: spontaneous or flow-triggered breath, initiate by patient generating flow above the preset flow threshold and the device switch from EPAP to IPAP S/T mode: spontaneous-timed mode, patient can initiate breath, the device will add up some mandatory breaths
18 Variables of BiPAP p T Rise time: in millisecond or the lower number the faster the rise p T Inspiratory time (Ti): set time limit for inhalation by IPAP, may apply to T only or S/T mode
19 Ti min Ti max Variables of BiPAP P Cycle Window Cycle is set to limit IPAP support Flow cycle: terminate by flow reduction, cycle sensitivity sets the inspiratory flow below peak flow Ti Time cycle: based on Ti settings
20 Respiratory Rate Pressure Pressure IPAP Spontaneous (S) Mode Spontaneous IPAP Spontaneous Cycle Cycle EPAP EPAP EPAP Spontaneous Trigger Spontaneous Trigger 0 Respiratory Cycle Time (sec) Respiratory Cycle Timed (T) Mode Ti Time IPAP Ti Time IPAP EPAP EPAP EPAP 0 Device Trigger Time (sec) Device Trigger
21 Pressure Pressure Spontaneous-Timed (S/T) Mode IPAP Spontaneous Ti Time IPAP Cycle EPAP EPAP EPAP 0 Spontaneous Trigger Device Trigger < 60/X < 60/X Respiratory Cycle Back up rate (BUR) = X Time (sec) Pressure Control (PC) Mode Ti Time IPAP Ti Time IPAP EPAP EPAP EPAP 0 Spontaneous Trigger < 60/X < 60/X Back up rate (BUR) = X Time (sec) Device Trigger
22 Respiratory Rate Volume Pressure Assured volume assured pressure support (AVAPS) Target RR Volume Target V t Ti Ti Min. Max. Spontaneous Ti IPAP V t Device Ti IPAP Ti Ti Min. Max. EPAP EPAP EPAP <60/X Flow Trigger Back up rate (BUR) = X Time >60/X Device Trigger Intelligent volume assured pressure support (ivaps)
23 Overnight monitoring to establish the nature of the sleep breathing abnormality REPTITIVE OBSTRUCTIVE APNEA OBSTRUCTIVE HYPOVENTILATION ISOLATED SLEEP HYPOVENTILATION Titrate CPAP to eliminate obstructive apneas, hypopneas, and flow limitation Set BPAP Prescribe CPAP Monitor closely: Adherence Follow-up 2 mo Resolution of Hypercapnia CPAP Yes Yes Maintains SpO 2 > 88% increase in TcCO 2 < 10mmHg No CONTINUE BPAP CONTINUE CPAP IF INITIAL AHI HIGH Sleep Med Clin 2017; 12; Fixed pressure EPAP for UAO IPAP to improve SpO 2 / CO 2 Aim for V T 8-10mg/kg IBW Fixed pressure EPAP for UAO or set AE 5-12 cmh 2 O Target V T 8-10mg/kg IBW Set PS MIN 4cmH 2 O, PS MAX 15cmH 2 O Monitor closely: Adherence, detailed data download from device Follow up 1-2 mo Yes Resolution of Hypercapnia ADJUNCTIVE THERAPIES INCL WEIGHT LOSS, PULMONARY REHAB, SURGERY No RETITRATE BPAP
24 Suggested Readings New approaches to positive airway pressure treatment in obstructive sleep apnea. Sleep Med Clin 2016;11:153-9 Positive airway pressure device technology past and present. Sleep Med Clin 2107;12: Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea. Sleep Breath 2017;21: Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Resp J 2017; 49: Initiation of noninvasive ventilation for sleep related hypoventilation disorders: advanced modes and devices. Chest 2018; 153(1):251-65
25 True success is not in the learning, but in its application to the benefit of mankind
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
More informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More informationChronic NIV in heart failure patients: ASV, NIV and CPAP
Chronic NIV in heart failure patients: ASV, NIV and CPAP João C. Winck, Marta Drummond, Miguel Gonçalves and Tiago Pinto Sleep disordered breathing (SDB), including OSA and central sleep apnoea (CSA),
More informationPap Settings. A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST
Pap Settings A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST Conflict of Interest Disclosure x 1. I do not have any relationships with any entities
More informationThe International Palestinian Congress in Sleep Medicine
The International Palestinian Congress in Sleep Medicine Temporomandibular Disorders and Sleep Apnea 26 and 27 October, 2017 Notre Dame Hotel, Jerusalem Using PAP Downloads to Manage Sleep Apnea Patients
More informationBi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
More informationTitration protocol reference guide
PN 1079754_Cover:22037_Cov_Canada 11/22/10 Philips Healthcare is part of Royal Philips Electronics How to reach us www.philips.com/healthcare healthcare@philips.com Asia +49 7031 463 2254 Europe, Middle
More informationNON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE
NON-INVASIVE VENTILATION MADE RIDICULOUSLY SIMPLE Jennifer Newitt, MD 3 rd year Pulmonary/Critical Care Fellow Mentor: Patrick Strollo Jr, MD Myth or Fact?!? Myth or Fact?!? Treatment for Obstructive
More informationHow to write bipap settings
How to write bipap settings 6-6-2013 Living On O2 for Life If you use a bipap machine, like I do, this post is for you. I've been using a bipap machine since 1993 which is a pretty long time. BiPAP 's
More information11/20/2015. Beyond CPAP. No relevant financial conflicts of interest. Kristie R Ross, M.D. November 12, Describe advanced ventilation options
Beyond CPAP Kristie R Ross, M.D. November 12, 2015 No relevant financial conflicts of interest Sponsored by The Warren Alpert Medical School of Brown University Describe advanced ventilation options Compare
More informationAuto Servo Ventilation Indications, Basics of Algorithm, and Titration
Auto Servo Ventilation Indications, Basics of Algorithm, and Titration 1 ASV Learning Objectives Understand the indications for Auto Servo Ventilation Differentiate obstructive versus central hypopneas
More informationChallenging Cases in Pediatric Polysomnography. Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep
Challenging Cases in Pediatric Polysomnography Fauziya Hassan, MBBS, MS Assistant Professor Pediatric Pulmonary and Sleep Conflict of Interest None pertaining to this topic Will be using some slides from
More informationMedical Affairs Policy
Medical Affairs Policy Service: Sleep Disorder Treatment: Positive Airway Pressure Devices and Oral Appliances (CPAP, BPAP, BiPAP, BiPAP ST, BiPAP with backup, BiPAP -Auto SV, VPAP, VPAP Adapt, VPAP adapt
More informationReasons Providers Use Bilevel
Reasons Providers Use Bilevel More comfort, improve therapy compliance Noncompliant OSA (NCOSA) 1 Scripts from lab referrals Central/Complex Sleep Apnea 2 For ventilations needs Restrictive Thoracic Disorders/Neuromuscular
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acquired central hypoventilation syndrome, NPPV in children with, 475 Acute cardiogenic pulmonary edema, PAP therapy in, 394 395 Adaptive
More informationMonitoring and Troubleshooting Adherence to PAP Devices and Understanding Device Downloads
Monitoring and Troubleshooting Adherence to PAP Devices and Understanding Device Downloads Christine Won, MD MS Medical Director, Yale Sleep Center Associate Professor of Medicine Yale School of Medicine
More informationPolicy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
More informationPEDIATRIC PAP TITRATION PROTOCOL
PURPOSE In order to provide the highest quality care for our patients, our sleep disorders facility adheres to the AASM Standards of Accreditation. The accompanying policy and procedure on pediatric titrations
More informationEffective Treatment for Obstructive Sleep Apnoea
Effective Treatment for Obstructive Sleep Apnoea The Series of Positive Airway Pressure devices from DeVilbiss Healthcare is designed to meet the varied needs of people suffering from Obstructive Sleep
More informationEffective Treatment for Obstructive Sleep Apnoea
Effective Treatment for Obstructive Sleep Apnoea The Series of Positive Airway Pressure devices from DeVilbiss Healthcare is designed to meet the varied needs of people suffering from Obstructive Sleep
More informationNatural performance. Introducing the BiPAP A30 - because ease of use and therapy efficacy are key to patient well-being
Natural performance Introducing the BiPAP A30 - because ease of use and therapy efficacy are key to patient well-being Because our innovations are inspired by you and your patients, the bi-level ventilator
More informationRon Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit.
Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four goals of home NIV Identify candidates
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO;
More informationLumis Tx: the all-in-one hospital ventilation solution
Lumis Tx: the all-in-one hospital ventilation solution The Lumis Tx is a multi-purpose non-invasive ventilator that treats the full range of respiratory conditions and is suitable for a variety of hospital
More informationBy Mark Bachand, RRT-NPS, RPFT. I have no actual or potential conflict of interest in relation to this presentation.
By Mark Bachand, RRT-NPS, RPFT I have no actual or potential conflict of interest in relation to this presentation. Objectives Review state protocols regarding CPAP use. Touch on the different modes that
More information(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationMonitoring: gas exchange, poly(somno)graphy or device in-built software?
Monitoring: gas exchange, poly(somno)graphy or device in-built software? Alessandro Amaddeo Noninvasive ventilation and Sleep Unit & Inserm U 955 Necker Hospital, Paris, France Inserm Institut national
More informationComplex Sleep Apnea. Can we do better? David Weed D.O.,FCCP,FAASM. September 8, 2016
Complex Sleep Apnea Can we do better? David Weed D.O.,FCCP,FAASM September 8, 2016 If you don t know where you are going, you ll end up somewhere else. Yogi Berra Objectives Discuss what syndromes comprise
More informationDisclosures. Michael Gunnuscio RPSGT, Bob Chase RRT, Umakanth Khatwa MD
Disclosures Michael Gunnuscio and Umakanth Khatwa have no financial relationships to disclose. Robert Chase works full time with North Atlantic Medical. Copyright 2014 Boston Children s Hospital 1 CPAP
More informationNoninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด
Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด Noninvasive Mechanical Ventilation Provide support without
More informationMechanical Ventilation 1. Shari McKeown, RRT Respiratory Services - VGH
Mechanical Ventilation 1 Shari McKeown, RRT Respiratory Services - VGH Objectives Describe indications for mcvent Describe types of breaths and modes of ventilation Describe compliance and resistance and
More informationCentral Sleep Apnoea during CPAP therapy First insights from a big data analysis. April 2018
Central Sleep Apnoea during CPAP therapy First insights from a big data analysis April 2018 Agenda Lexicon Introduction to Big Data The findings of the Trajectories of Emergent Central Sleep Apnea during
More informationPRODUCT TRAINING TREND II
Product Training TREND II HOFFRICHTER GmbH 1 General Introduction Complete system spectrum for CPAP therapy TREND II TREND II AUTO TREND II BILEVEL TREND II BILEVEL ST20 AquaTREND uni Therapy Humidifier
More informationPAP Therapy Devices: Delivering the Right Therapy To The Right Patient. Ryan Schmidt, BS, RRT Clinical Specialist Philips Respironics
PAP Therapy Devices: Delivering the Right Therapy To The Right Patient Ryan Schmidt, BS, RRT Clinical Specialist Philips Respironics Conflict of Interest Disclosure(s) I do not have any potential conflicts
More informationBest Match. Non-Invasive Ventilation. WSS Fall Objectives. BiPAP AVAPS Patient Types 9/10/2018. Advanced Algorithms - Clinical Applications
WSS Fall 2018 Advanced Algorithms - Clinical Applications Average Volume Assured Ventilation (AVAPS) Auto Servo Ventilation (SV) Hank Hart BS, LPN Objectives Differentiate between BiPAP AVAPS and BiPAP
More informationEnclosed on Page 5 is an authorization form to release your health information.
Monitor Medical, Inc. "The CPAP Co." Ph: (877) 569-9436 Fax: (888) 773-2854 www.monitormedical.com Dear Medicare Beneficiary: Thank you for selecting Monitor Medical, Inc. to provide you with all of your
More informationNIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH
NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940
More informationDIGITAL AUTO-TRAK + Bi-FLEX + AUTO Bi-LEVEL THE POWER OF. Sometimes when three come together the results can be quite extraordinary. Unique even.
DIGITAL AUTO-TRAK + Bi-FLEX + AUTO Bi-LEVEL THE POWER OF 3 Sometimes when three come together the results can be quite extraordinary. Unique even. W W W. R E S P I R O N I C S. C O M THE BiPAP M SERIES
More informationWhat is the next best step?
Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO;
More informationAdvanced Algorithms for Sleep Disordered Breathing. 1.5 AARC and AAST CEU credits
Advanced Algorithms for Sleep Disordered Breathing 1.5 AARC and AAST CEU credits Learning Objectives Restate the technology of auto adjusting expiratory pressure, servo ventilation, volume assured pressure
More informationManagement of OSA. saurabh maji
Management of OSA saurabh maji INTRODUCTION Obstructive sleep apnea is a major public health problem Prevalence of OSAS in INDIA is 2.4% to 4.96% in men and 1% to 2 % in women In the rest of the world
More informationBPAP 25A Training A.Giudice,RPSGT Clinical Education Manager
1 Solutions in Sleep Therapy BPAP 25A Training A.Giudice,RPSGT Clinical Education Manager 2 To access press and hold the On/Off Button and Ramp Button and at the same time connect the power cord into the
More informationApnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD
Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing Alan S Maisel MD Triumvirate of Health-public awareness 1.8% Sleep Physical Fitness Nutrition 91.3% 99.9% Sleep is important to
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO
More informationCPAP. The CPAP will be covered
CPAP CPAP Did your patient have a face to face visit with the physician prior to having a sleep study that documented (1) Sleep History and symptoms and/or (2) Epworth Scale and/or (3) Physical Examination?
More informationPositive Pressure Therapy
Positive Pressure Therapy Positive Pressure Therapy...2 What is Sleep Apnea?....2 Positive Pressure Machines..................................................... 4 Types..................................................................................
More informationProvider guide. DreamStation CPAP DreamStation CPAP Pro DreamStation Auto CPAP DreamStation BiPAP Pro DreamStation Auto BiPAP
Provider guide DreamStation CPAP DreamStation CPAP Pro DreamStation Auto CPAP DreamStation BiPAP Pro DreamStation Auto BiPAP IMPORTANT! Remove this guide before giving the device to the patient. Only medical
More informationCase 1. Level of difficulty: 2/5
Case 1 Level of difficulty: 2/5 Summary Settings in the ventilator BULBAR ALS Ventilation 24h/24, Good tolerance PaO2 82; PaCO2 : 42, ph=7,42 (under ventilation) Mode: S/T Main parameters : Pressure Support
More informationPositive Airway Pressure Systems for Sleep Disordered Breathing
Positive Airway Pressure Systems for Sleep Disordered Breathing Lori Pickrell, RRT Account Manager Roberts Home Medical Lpickrell@robertshomemedical.com Objectives Upon completion of the session, attendees
More informationDreamStation. Provider guide
Provider guide Accessing the Provider mode screens Accessing Provider mode unlocks settings that cannot be modified by the user. To access Provider mode: 1. ce the device is powered, press and hold both
More informationName of Policy: Noninvasive Positive Pressure Ventilation
Name of Policy: Noninvasive Positive Pressure Ventilation Policy #: 203 Latest Review Date: April 2014 Category: Durable Medical Equipment Policy Grade: Effective July 31, 2013: Active Policy but no longer
More informationGoals Session Putting it all Together
Goals Session Putting it all Together Adherence to therapy Case presentations Treatment issues Charles Atwood, MD, FCCP, FAASM University of Pittsburgh Disclosures Advisory - Carecore National; Philips;
More informationSleep Apnea Treatment Options, A Year After ASV
Sleep Apnea Treatment Options, A Year After ASV Nancy Collop, MD, FAASM Emory University Associated Professional Sleep Societies, LLC 1 Conflict of Interest Disclosures for Speakers x 1. I do not have
More informationA 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
More informationHow To Set Up A Ven.lator: Standard Versus High Pressure
How To Set Up A Ven.lator: Standard Versus High Pressure Dean R. Hess PhD RRT Assistant Director of Respiratory Care MassachuseBs General Hospital Associate Professor of Anesthesia Harvard Medical School
More informationWHAT DO YOU WANT FROM A HOME VENTILATION SYSTEM? 8322_RS_HomeNIV_brochure_v14.ind1 1 4/7/06 12:57:35
WHAT DO YOU WANT FROM A HOME VENTILATION SYSTEM? 8322_RS_HomeNIV_brochure_v14.ind1 1 4/7/06 12:57:35 D I L E M M A DIFFERENT VENTILATORS DIFFERENT ALGORITHMS TO KNOW YOU VE CHANGED PATIENT LIVES?PATIENT??
More informationW J R. World Journal of Respirology. Effectiveness of adaptive servo-ventilation. Abstract REVIEW. Yasuhiro Tomita, Takatoshi Kasai
W J R World Journal of Respirology Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.5320/wjr.v5.i2.112 World J Respirol 2015 July 28; 5(2): 112-125
More informationAverage volume-assured pressure support
Focused review Average volume-assured pressure support Abdurahim Aloud MD Abstract Average volume-assured pressure support (AVAPS) is a relatively new mode of noninvasive positive pressure ventilation
More informationA simple solution for your complex patients
A simple solution for your complex patients The market-leading servo ventilation device System One BiPAP autosv Advanced simplifies treating complex sleep-disordered breathing patients Developed for your
More informationObstructive Sleep Apnea Syndrome. Common sleep disorder causes high blood pressure and heart attacks
Obstructive Sleep Apnea Syndrome Common sleep disorder causes high blood pressure and heart attacks Message: Sleep apnea is very common. It is estimated that 158 million people worldwide suffer from sleep
More informationChoosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting Lisa F. Wolfe MD Northwestern University Chicago, Illinois Choosing the Appropriate Mode of PAP Therapy in the Perioperative Setting
More informationNON INVASIVE LIFE SAVERS. Non Invasive Ventilation (NIV)
Table 1. NIV: Mechanisms Of Action Decreases work of breathing Increases functional residual capacity Recruits collapsed alveoli Improves respiratory gas exchange Reverses hypoventilation Maintains upper
More informationCAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center
FOCUS Fall 2018 CAPNOGRAPHY in the SLEEP CENTER Julie DeWitte, RCP, RPSGT, RST Assistant Department Administrator Kaiser Permanente Fontana Sleep Center 1 Learning Objectives The future of in laboratory
More informationSleep Lab Titration Guide
Sleep Lab Titration Guide Table of Contents Introduction 1 S9 VPAP Tx Lab System... 2 Delivering Efficient, Consistent Results... 3 ResMed Therapy Modes and Algorithms, Specifications.. 4 S9 VPAP Tx Accessories...
More informationIdentification and Treatment of the Patient with Sleep Related Hypoventilation
Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures
More informationWhich device for your patient?
Which device for your patient? Which device for your patient? Description Page Sleep therapy 4-5 Home NIV 6-7 Airway clearance 8 Oxygen 8-9 Patient interface 10-11 SDB screening and diagnostic 12-13 EncorePro
More informationNon-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life. The North Study
Non-Invasive Ventilation of the Restricted Thorax: Effects of Ventilator Modality on Quality of Life The North Study Lorna Cummins RRT, Pat Hanly MD, Andrea Loewen MD, Karen Rimmer MD Raymond Tye RRT,
More informationTitration and monitoring of CPAP in infants
Titration and monitoring of CPAP in infants Brigitte Fauroux, MD PhD Pediatric Noninvasive Ventilation and Sleep Unit Necker University Hospital & Inserm U 955 Paris, France Inserm Institut national de
More informationTHE NEW HOME FOR C-FLEX IS BUILT ON THE IDEA THAT A BETTER NIGHT S SLEEP COMES FROM PRODUCTS THAT ARE EASY TO USE.
THE NEW HOME FOR C-FLEX IS BUILT ON THE IDEA THAT A BETTER NIGHT S SLEEP COMES FROM PRODUCTS THAT ARE EASY TO USE. W W W. M S E R I E S. R E S P I R O N I C S. C O M INTRODUCING THE REMSTAR M SERIES SLEEP
More informationAlaska Sleep Education Center
Alaska Sleep Education Center The 3 Types of Sleep Apnea Explained: Obstructive, Central, & Mixed Posted by Kevin Phillips on Jan 28, 2015 6:53:00 PM Sleep apnea is a very common sleep disorder, affecting
More informationCOMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center
COMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center CENTRAL APNEA Central Apnea Index > 5 ( >50% of apnea are central) Mayo Clinic Proc 1990; 65:1255 APNEA AT SLEEP ONSET
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationProvider guide. DreamStation
Provider guide DreamStation CPAP CPAP Pro Auto CPAP BiPAP Pro Auto BiPAP IMPORTANT! Remove this guide before giving the device to the patient. Only medical professionals should adjust pressure settings.
More informationNew Government O2 Criteria and Expert Panel. Jennifer Despain, RPSGT, RST, AS
New Government O2 Criteria and Expert Panel Jennifer Despain, RPSGT, RST, AS Lead Sleep Technologist, Central Utah Clinic Sleep Disorders Center; Provo, Utah Objectives: Review new government O2 criteria
More informationEdoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica
Convegno Pneumologia 2016 Milano 16-18 giugno 2016 Centro Congressi Palazzo delle Stelline Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Central apnea 10 second
More informationThe Treatment of Complex Central Sleep Apnea (CompCSA)
The Treatment of Complex Central Sleep Apnea (CompCSA) Including Cheyne-Stokes Breathing (CSB), with Respironics BiPAP autosv Advanced therapy system Authors: Shahrokh Javaheri, MD 1, Mark Goetting, MD
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Accidents. See Motor vehicle accidents. Acetazolamide, in OSA therapy, 531 Acetylcholinesterase inhibitors, in OSA therapy, 532 533 Acromegaly,
More informationa new beginning in managing CSA ResMed.com/AirSolutions
a new beginning in managing CSA ResMed.com/AirSolutions As your partner in patient care, ResMed gives you more clinical tools to manage patients with breathing disorders that can sometimes be challenging
More informationClinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea
Special Article Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea Positive Airway Pressure Titration Task Force of the American Academy of
More informationMario Kinsella MD FAASM 10/5/2016
Mario Kinsella MD FAASM 10/5/2016 Repetitive episodes of apnea or reduced airflow Due to upper airway obstruction during sleep Patients often obese Often have hypertension or DM 1 Obstructive apneas, hypopneas,
More informationMedicare C/D Medical Coverage Policy. Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders
Medicare C/D Medical Coverage Policy Respiratory Assist Devices for Obstructive Sleep Apnea and Breathing Related Sleep Disorders Origination: June 26, 2000 Review Date: January 18, 2017 Next Review January,
More informationWhat is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS)
Have a Good Sleep? Estimated 70 million Americans have clinically significant sleep problems Chronic insomnias report decreased quality of life, memory and attention problems, decreased physical health
More informationTitration protocol reference guide
Titration protocol reference guide 2 Notes Description Page Patient types 4 Titration protocol goals 5 CPAP CPAP protocol 6-7 Auto CPAP Auto CPAP protocol 8-9 BiPAP S BiPAP S protocol 10-11 BiPAP Auto
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationMechanical Ventilation Principles and Practices
Mechanical Ventilation Principles and Practices Dr LAU Chun Wing Arthur Department of Intensive Care Pamela Youde Nethersole Eastern Hospital 6 October 2009 In this lecture, you will learn Major concepts
More informationHypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment
Hypoventilation? Obstructive Sleep Apnea? Different Tests, Different Treatment Judith R. Fischer, MSLS, Editor, Ventilator-Assisted Living (fischer.judith@sbcglobal.net) Thanks to Josh Benditt, MD, University
More informationAFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL A. Definition of Therapy: 1. Cough machine: 4 sets of 5 breaths with a goal of I:E pressures approximately the same of 30-40. Inhale time = 1 second, exhale
More informationUnderstanding PAP. A Guide to Positive Airway Pressure (PAP) Therapy
Understanding PAP A Guide to Positive Airway Pressure (PAP) Therapy Understanding PAP A Guide to Positive Airway Pressure (PAP) Therapy This guide will help you understand why treating sleep apnea is important,
More informationResScan Report Interpretation Guide. FOR CLINICAL USE ONLY V1.0 June, 2011
ResScan Report Interpretation Guide FOR CLINICAL USE ONLY V1.0 June, 2011 ResMed Software Support Hours 5:30 AM to 5:30 PM (Pacific Time) Monday Friday Phone +1 (800) 424-0737, Option 6 Email TechSupportUSA@resmed.com
More informationAPRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
More informationWhat is an APAP Machine?
APAP Machines Features and Options What is an APAP Machine? An APAP machine is a special type of CPAP device that delivers therapy air at varying pressures based on your breathing, instead of blowing at
More informationJulie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist
Julie Zimmerman, MSN, RN, CCRN Clinical Nurse Specialist Objectives Define capnography vs. end tidal CO2 (EtCO 2 ) Identify what normal vs. abnormal EtCO2 values mean and what to do Understand when to
More informationMechanical Ventilation of the Patient with Neuromuscular Disease
Mechanical Ventilation of the Patient with Neuromuscular Disease Dean Hess PhD RRT Associate Professor of Anesthesia, Harvard Medical School Assistant Director of Respiratory Care, Massachusetts General
More informationClinical update of BiPAP autosv for treatment of Sleep Disordered Breathing
BiPAP autosv Advanced System One Authors: Dr. Teofilo Lee-Chiong, Medical Liaison, Philips Respironics Cheryl Needham, Senior Clinical Marketing Manager, Philips Respironics Bill Hardy, Senior Scientific
More informationPain patient with sleep-disordered breathing
Pain patient with sleep-disordered breathing Clinical scenario: A 50-year old female with a history of acid reflux, fibromyalgia, spinal stenosis and degenerative disk disease s/p C3/C4 disk fusion, depression
More informationHealth Care Providers:
Health Care Providers: 1. What is SERVE-HF? SERVE-HF is a multinational, multi-center, randomized controlled trial designed to assess whether treatment of predominantly Central Sleep Apnea with Adaptive
More information