philips technologies by olu albert
TRANSCRIPT
Philips Technologies
Philips Technologies
• Digital AutoTrak• Digital AutoTrak sensitive• AVAPS• AVAPS rate• AVAPS-AE
Digital AutoTrak (DAT)
Components of DAT
A. Recognizes and compensates for system leaks 1. Leak ToleranceB. Provides 2 methods of inspiratory Trigger 2. Volume Trigger 3. Shape TriggerC. Provides 4 methods of expiratory cycling 4. Spontaneous Expiratory Threshold (SET) 5. Shape Trigger/Cycle 6. Flow Reversal 7. Maximum IPAP time
1. Leak Tolerance
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1 = Increase in flow & stabilizes most part of the inspiratory phase
2 = Decrease in flow & stabilizes most part of the expiratory phase
= Original Baseline/Beginning of inspiration/End of expiratory cycle
= Change in leakage flow/New Baseline Flow
Inspiratory Triggering
2. Volume Trigger
3. Shape Trigger
Patient Flow = Total Flow- Circuit Leak
Shape Signal (Appears as a shadow image of the patient actual flow)
The shape trigger functions as a “sensitivity threshold” for inspiration and expiration
Expiratory Cycling
4. Spontaneous Expiratory Threshold
Actual FlowThe slope of the SET is calculated at the beginning of the breath and signal rises in proportion to the inspiratory flow rate of each breath
When the SET signal crosses the flow signal, EPAP is triggered
5. Shape Trigger/Cycle
The shape signal also functions as a “sensitivity threshold” for Expiration, when patient flow crosses the shape signal , it cycles into EPAP
6. Flow Reversal
During flow reversal, the unit in the process Of cycling into EPAP when the leak occurs
Flow reversal does not allow trigger to IPAP without returning to EPAP. This keeps “breath stacking” from occurring
7. Maximum IPAP Time
DAT Components Modes
1. Leak Tolerance All Modes
2. Volume Trigger All Modes (except T & CV)
3. Shape Trigger All Modes (except T and CV
4. SET All Modes (except T, CV, AC & SIMV)
5. Shape Cycle All Modes (except T and CV)
6. Flow Reversal All Modes
7. IPAP Time S, S/T, T, PC
Bottom line!!!The DAT detects and compensates for unintentional leaks in the system and automatically adjusts trigger and cycle algorithms to maintain optimum performance in the presence of leaks
DAT Sensitive
Sensitive Auto-Trak is an enhancement to the DAT algorithm that improves patient and machine synchrony for patients with minimal respiratory effort. DAT refines the baseline trigger and cycle sensitivity thresholds.
Hybrid Modes
1. AVAPS
2. AVAPS-AE
What are hybrid modes?
Pressure Support Ventilation modes with targeted volume delivery
What is AVAPS?
• Average Volume Assured Pressure Support
• Available in S, S/T, PC, and T modes (Not a standalone mode!!!)
• It maintains tidal volume (VT) equal to or greater than the target volume setting by automatically controlling the PS
AVAPS rate
• Allows the adjustment of the maximum rate at which PS automatically changes to achieve the target volume
AVAPS Speed per Device
Fixed 2.5 cmH2O / min
0.5 to 5 cmH2O / min
1 to 5cmH2O / min
How does AVAPS Work? AVAPS automatically adapts pressure support to patient needs to guarantee an average tidal volume.
Target Vt
EPAP
IPAP
± 1 to 3 cmH2O over 1 min
IPAP min
IPAP max
Main Settings:
• Can be accessed in S, S/T, PC and T modes• AVAPS (set based on IBW 6-8ml/kg)• IPAP max• IPAP min• EPAP• RR• Ti
AVAPS-AE
What is AVAPS-AE?
AVAPS-AE is a auto-titration mode of noninvasive ventilation designed to better treat respiratory insufficiency patients (OHS, COPD and NMD) in the hospital and homecare environments
Components of AVAPS-AE
• AVAPS
• Automatic EPAP (AE)
• Auto RR
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AVAPS AE settings
EPAP
Target Vt
IPAP PS min
PS max
AVAPS-AEMaintaining Tidal volume and Airway patency
EPAP min
EPAP max
Resistance
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Theory of Operation
Upper Airway Resistance
Device Pressure
P search
crit
Ptherapy
P searchopt
Illustration courtesy of Krames Medical Illustration.
AVAPS-AE: Auto EPAP proactive analysis
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Popt – Optimal Pressure Search
(High Pressure Search)
EPAP
P opt
P opt
P therapy
P therapy
Critical Pressure Searches
(Low Pressure Search)
P crit
P crit
P therapy
EPAP
P crit
P therapy
Popt
Pcrit
Auto EPAP Proactive Analysis
Pther
Popt
Pres
sure
Resistance
Pcrit
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P opt
SET BRUsed for the rest of the night
AVAPS-AEAuto Backup rate
121
2
3
4
567
8
9
10
11
1st hour
50 breaths Sliding window
BR continually Updates
1h
BR set
15
30
45
560
BR=Actual Rate minus 2
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Auto backup rateM
ovin
g br
eath
rate
Minimum autobackup rate
Spontaneous breaths
Time 50 breaths
10
Calculated spontaneous rateTarget auto
backup rate
Targeted auto backup rate is 2 bpm below avg. spontaneous
rate
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Bpm
Auto backup rate
Spontaneous BreathsTimed Breaths
Target auto backup rate
10 Auto backup rate buffer zone
The auto backup rate is buffered by spontaneous triggers to promote synchrony with
the device
• The buffer is reduced or eliminated by timed triggers.
• The patient will be guided back to the targeted backup rate
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Bpm
M
ovin
g br
eath
rate
Time (Night time session)
Bottom line: AVAPS-AE is an “auto-titrating” BIPAP mode that will respond to:1) Hypoventilation (AVAPS)2) Airway Closure (AE)3) Inconsistent Respiration and /or Apnea (Auto RR)