Pap Settings. A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST

Transcription

1 Pap Settings A review of fine tuning settings For patient comfort and compliance Wendy Cook BSRT Judy Salisbury RPGST

2 Conflict of Interest Disclosure x 1. I do not have any relationships with any entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, OR 2. I have the following relationships with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Type of Potential Conflict Details of Potential Conflict Grant/Research Support Consultant Speakers Bureaus Financial support Other x 3. The material presented in this lecture has no relationship with any of these potential conflicts, OR 4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references are provided as support for this lecture:

3 CPAP Settings Ramp- designed to make the beginning of therapy more comfortable. Available in all modes In auto set, it is the time it takes to go from start pressure to the minimum therapy pressure, before auto algorithm starts.

4 Cpap settings EPR Maintains optimal treatment for the patient during inhalation, and it reduces the delivery mask pressure during exhalation Available in cpap, auto set modes Full time, ramp time only Will not go below 4cmH20.

5 Cpap settings Climate control Used with climate control tubing and humidification Intelligent system- controls humidity and climate line provides constant humidity levels during treatment Prevents dry mouth and nose Can be set to auto or manual

6 Climate control Auto Recommended No need to adjust settings Tubing temperature set at 81 degrees Climate control automatically adjusts humidifier to maintain a level of 85% humidity Protects against rainout

7 Climate control manual Personalized settings Optional for patient comfort Tube temperature and humidity levels are set independently May need frequent adjustments to prevent rainout More flexibility over settings

8 Rain out Refers to condensation that accumulates in the mask or tubing, caused by using heated humidity in air that cools as it travels through the tubing. If rainout occurs, first adjust the tube temperature up, if it becomes to warm or rainout continues decrease the humidity level

9 Sleep Report Information Shows usage, mask seal, and humidity status, when set to plus mode it also shows AHI and events Airplane mode- can be used on a plane, meets FAA approval

10 Trigger, Cycle Sensitivity Trigger Sensitivity- Determines how easy or difficult it is to initiate a breath Cycle Sensitivity- Determines exactly when the patient start to expire

11 Sensitivity Trigger & Cycle These settings help the synchrony between patient and machine to decrease the work of breathing. The more sensitive the trigger and cycle settings (High and Very High) provide flexibility for high resistance Example would be for pediatrics or patients with COPD

12 Trigger& Sensitivity cont Less sensitive settings (Low and Very Low) provide flexibility for patients that are auto triggering Caused by restrictive lung diseases, and cardiogenic artifact

13 Bi-level therapy Bipap Ideal for patients that have a hard time adjusting to cpap or continuous positive pressure Allows settings to deliver a higher inspiratory pressure, and drops during exhalation to a lower pressure Feels more natural to most patients

14 Bi-level Bipap ST- Allows a bilevel pressure that can also have a back up rate set to provide patientventilator synchrony

15 Auto Bi-level Auto bipap- Uses advanced technologies to treat sleep apnea patients who need pressure support Adaptive servo-ventilator (ASV)- targets the patient s own recent minute ventilation Bipap ST A- Highly effective ventilator that allows you to proactively monitor and follow up with respiratory insufficiency patients

16 Bi-level Bipap ST mode Set a back up rate Central hypoventilation Significant number of centrals Very low respiratory rate Unreliable trigger cycles IPAP/EPAP due to muscle weakness Set slightly less than the patients respiratory rate Ipap time between 30-40% of cycle time

17 Bi-Level Fine tuning IPAP MAX- Is the maximum amount of time the Vpap will stay in IPAP mode during a breath The patient can spend less time in IPAP than the number you set, but they can t spend more time if it is set to short. If it is set to short the patient s inspiratory effort will be cut short.

18 IPAP Min IPAP Min- The minimum amount of time the bilevel will sty in IPAP. The default setting is.1 The only patient that you wnt different than.1 is restrictive lung patients They should be set according to their respiratory rate and disease state.

19 Rise time- Rise time The smaller the number set, the quicker the bipap changes from EPAP to IPAP The larger the number set the slower the rise from EPAP to IPAP Widely under utilized If a patient does not tolerate bi-level this would be the first setting to check.especially if they have COPD!

20 Rise time cont If a patient states they do not have a long enough time to exhale If they say they feel like they are blowing up If they say it feels like the breath is stacking up and they have to open their mouth to let out the pressure, the rise time is not set properly for them Consider increasing the rise time until the patient states it feels better or more normal

21 Hands On Workshop! Pick a mask that you feel will fit you comfortably. Bi-level settings Part One: IPAP 10 EPAP 6 Rise time Min Ti Max 2.0 Ti Min.03 Attach mask and breath normally and notice how the pressure is delivered.

22 Next Settings are the same except increase the Ti Max to 4.0 You will notice at Ti max of 2.0 it will only allow you to inhale for 2 seconds, this may be fine for some but way to short for others When you increase the Ti Max to 4.0 you can stay in the inspiratory phase longer if you want to. When you initiate exhalation it is allowed to cycle

23 Settings IPAP 10 EPAP 6 Rise time MIN Ti Max 4.0 Ti Min 0.3 Breath normally and notice if the breath feels natural. For many it will feel fine. For some it will feel like you want more time to exhale before inhalation begins. Try to exhale for at least 4 seconds

24 Next Keep ll of the settings the same except for the rise time Change the rise time to 450 When you exhale take your time and try to empty your lungs It should feel easier to stay in exhalation longer before it cycles to inhalation.

25 Importance Rise time and Ti Max are very important to patient comfort and compliance. Especially for patients who need a longer expiratory time. These types pf patients are the COPD patients. Their disease demands more time to get air out of their lungs, because of the disease they trap air, if we don t give them time to exhale they will feel like they are blowing up. It is an easy fix to help them tolerate therapy Compliance will increase and so will their comfort

26 References Antonescu-Turcu A, Parthasarathy S. CPAP and Bi-level PAP Therapy: New and Established Roles. Respiratory care. 2010;55(9): Resmed User guides Resmed Academy 2017