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Respironics BiPAP 

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  1. Respironics BiPAP How do I guarantee ventilation efficiency ? How do I ensure tolerance to ventilation ? How do I know the system is reliable? Etc… Efficiency Comfort Safety Versatility Prediction

  2. Respironics Technology and Know How How do I achieve an optimised patient/ventilator Synchronisation? How do I guarantee ventilation Efficiency? Efficiency Comfort Safety Versatility Prediction

  3. Respironics Technology and Know-How AVAPSTM • Late 80’s, Respironics first introduced BiPAP technology and Auto-TRAK Algorithm for better patient/ventilator synchronization • Chest 1997 : “Performance Characteristics of Bilevel Pressure Ventilators” • AJRCCM2001 : “Noninvasive Ventilator Triggering in Chronic Obstructive Pulmonary Disease” • Chest2005 :  “Performance Characteristics of 10 Home Mechanical Ventilators in Pressure-Support Mode” • 2003: Respironics introduced AVAPS for improved ventilation comfort and efficiency without compromise

  4. Blower Flow Pressure Patient Circuit Air Filter AirflowSensor Proportional Valve Ambient Air Exhaust Respironics BiPAP Technology Respironics BiPAP Blower only • Blower works at a constant speed The blower inertia does not affect patient ventilation • The valve controls the flow provided by the blower Response time close to 0 : able to provide high patient breath rate and high rise time, short fall time Responds to extra flow demand (225LPM at 25cmH2O) Compensates for most leaks Reduces respiratory work

  5. Respironics BiPAP VentilatorsBiPAP Harmony and BiPAP Synchrony • Same Technology: BiPAP • Blower works at a constant speed • The valve controls the flow provided by the blower • Digital Auto-TRAK Sensitivity • Same Platform: • Integrated heated humidifier • SmartCard • Compatible with both Encore Pro software and Stardust II polygraph • Small and light: • 1,8 Kg • 24 x 17 x 11 = 4,5 L

  6. « Unlike manually controlled triggers, Auto-TRAK does the work for you » • Automatic inspiratory trigger and expiratory cycle • Leak compensation over 60LPM • Leak estimation to calculate Vte at 15% accuracy Characteristics Advantages • Efficient Ventilation: Leaks are all compensated. Trigger thresholds automatically adjust according to the changes in leaks and patient respiratory mechanics • Easy Ventilation: No trigger adjustments are required • Safe Ventilation: Alarms & monitoring of Vte, MinVent

  7. Digital Auto-TRAK Algorithm • Inspiration: when the patient makes an effort to inspire, the flow naturally increases • Expiration: when the patient makes an effort to expire, the flow naturally decreases Flow Shape signal: Delayed waveform crossing patient flow in case of flow direction changes Detects an accumulated 6ml volume above the base line

  8. Digital Auto-TRAK Algorithm • Spontaneous Expiratory Threshold: electronic signals that rises in proportion of tidal volume • Flow Reversal: allows detection of excessive mouth leak. If the flow increases by more than 10% of the peak flow in a short period of time then switch to EPAP • Safety Feature: inspiratory time cannot exceed 3 seconds

  9. Digital Auto-TRAKTM Sensitivity « A proven technology » “Patient-ventilator synchrony is a key to the success of long-term Home NIV as dysynchrony causes patient intolerance” Chest2005 :  “Performance Characteristics of 10 Home Mechanical Ventilators in Pressure-Support Mode”

  10. Ventilation Modes & Settings How do I set ventilation parameters? How do I adapt settings to patients’ needs? Efficiency Comfort Safety Versatility Prediction

  11. « The management strategy is based on an individualized assessment of disease severity and response to various therapies. » Source: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease GOLD scientific committee - NHLBI/WHO workshop summary - AJRCCM 2001 Therapy depends upon the patient’s pathology type and severity

  12. BiPAP Synchrony / BiPAP Harmony

  13. IPAP Pressure Pressure Pressure Pressure Patient inspiratory and expiratory efforts Patient inspiratory and expiratory efforts Ti Patient Ti Patient IPAP Spontaneous Spontaneous EPAP EPAP S S T T S S IPAP Ti Patient Ti Patient Ti Machine Ti Machine Ti Patient Ti Patient Spontaneous Timed Spontaneous Timed EPAP Ti max Ti max 60/RR 60/RR T T T T Operational CharacteristicsModes Description

  14. IPAP IPAP Pressure Pressure Ti Machine Ti Machine Ti Machine Timed EPAP EPAP Ti Machine Ti Machine Ti Machine Pressure Control 60/RR T T Operational CharacteristicsMode Description

  15. Respironics Ventilation Modes S mode • IPAP • EPAP P/C mode • IPAP • EPAP • RR • Ti T mode • IPAP • EPAP • RR • Ti S/T mode • IPAP • EPAP • RR • Ti Spontaneous breaths Spontaneous breaths with back up respiratory rate Ti fixed for every breath Each breath is controlled Patient can trigger to inspiration

  16. AVAPSTM Feature Variation of 1cmH2O maximum per minute PS ±ΔP PS Ensure Averaged Vt • AVAPS available on S, S/T, PC and T modes • IPAP automatically adjusts from breath to breath to ensure an averaged Vt • Settings: IPAPmin, IPAPmax and Target Vt

  17. AVAPSTM Suggested Settings • Set the Target Tidal Volume To the displayed patient tidal volume when ventilated on S/T mode or To 8ml/kg of ideal weight and adjust depending on pathology, patient tolerance and clinical outcome Set IPAP Limits IPAP max = 25 to 30 cmH2Odepending on patient pathology and IPAP min = EPAP + 4 cmH2O

  18. Respironics Alarms • Disconnection: OFF, 15, 60 sec. • High flow rate and small pressure • Low minute Ventilation: from 0 to 99 LPM • Apnea alarm: OFF, 10, 20, 30 sec. • Low tidal Volume (AVAPS only): OFF (0) / ON (1) • When the target tidal volume is not reached whereas the IPAP is at the set IPAP max level Efficiency Comfort Safety Versatility Prediction

  19. Battery Pack for Portable Use & Increased Safety • Can be connected to all our BiPAP • Universal battery charger 100/240V for ease of travel • 7hrs autonomy at IPAP 20 / EPAP 4 cmH2O and 12 BPM with BiPAP Harmony & BiPAP Synchrony Efficiency Comfort Safety Versatility Prediction

  20. Easily Set the Ventilation on our BiPAP Palm Pilot remote control SleepLink BiPAP Harmony BiPAP Synchrony Computer with PC Direct software

  21. Easily Set the Ventilation on our BiPAP Palm Pilot remote Control PC Direct Software

  22. Patient’s Follow Up Maintain an efficient Ventilation and avoid exacerbation episodes Get all details on patient’s ventilation Frequently check therapy efficiency • Detect abnormal respiratory patterns • Adjust settings Efficiency Comfort Safety Versatility Prediction

  23. 100% fit,100% of the time Replaces silicone masks of patients already on therapy • A solution to mouth breathers and acute NIV patients Optimize comfort and drive therapy acceptance of new patients Smaller and lighter masks for patients who are looking for comfortable alternatives. Comfort with Style.

  24. Efficiency Comfort Prediction Safety Versatility BiPAP Harmony Battery Pack BiPAP Synchrony (featuring AVAPS) Battery Pack