COPD patients have a high work of breathing (WOB) and experience difficulty exhaling air from their lungs.
- Pressure support (PS) assists patients’ breathing to enable more volume to enter their lungs in a shorter period of time, decreasing their WOB.
- Reducing or normalising PCO2 levels in COPD patients may require the delivery of high pressures. 1
- ResMed's bilevel devices deliver a wide line-up of PS settings, settable in increments of 0.2 cm H2O up to a PS of 40 cm H2O.
- PS decreases the patient’s work of breathing, which lowers their respiratory rate and allows more time to exhale.
- Good synchronisation and quick motor response time also contribute towards the quick delivery of inspiratory volume.
Less time spent in inspiration allows more time in expiration, allowing intrinsic PEEP to decrease further, leading to a decrease in WOB.
- ResMed's TiControl™ feature allows clinicians to set a maximum value for time spent in inspiration, which ensures effective cycling to increase the length of time the patient stays in expiration.
- Fast rise times and quick responses to patient effort are achieved through ResMed’s unique, low inertia motor technology.
- With ResMed's Stellar™ ventilators, EPAP (expiratory pressure) can be set from 2 cm H2O to 25 cm H2O or up to the set level of IPAP (inspiratory pressure).
It is essential to maintain reliable breath triggering and cycling synchronisation between the patient and the device.
- On all ResMed devices, the VSync leak management algorithm works in sync with the TiControl feature. VSync monitors and compensates for leak by continuously and automatically adjusting the baseline flow, while TiControl assures a minimum and maximum inspiratory time.
- Trigger and cycle adjustment can also help with synchronisation.
COPD patients most commonly require supplemental oxygen with NIV.
- Stellar ventilators enable oxygen to be added at the back of the device for more accurate delivery of O2; up to 30L/min can be added.
- SpO2 can be monitored to help titrate oxygen.
- FiO2 can be measured and monitored directly on the Stellar LCD screen when required.
The key to treating patients with COPD is patient acceptance and adherence to the therapy (especially at night time).
- ResMed products facilitate a fine adjustment of trigger and cycle sensitivities, as well as rise and fall time settings to optimise comfort and ease of breathing.
- Comprehensive patient monitoring options also assist in promoting the patient’s adherence to therapy.
COPD patients may also have overlap syndrome - COPD with Obstructive Sleep Apnoea (OSA).
- If overlap syndrome is diagnosed, EPAP is also titrated to overcome the upper airway collapse due to OSA.
- AHI data viewed on the Stellar Info screen or via ResScan™ will help you identify the need for EPAP adjustment.
- High-resolution flow data can help titrate EPAP and identify PEEPi.
Integrated humidification can be used to support the patient's breathing.
- ResMed's H4i™ and H5i™ heated humidifiers integrate with compatible ResMed devices.
During all stages of COPD, it is vital to monitor the patient and their progress.
- ResMed's advanced data management solutions (device and card data storage with high-resolution flow and pressure data, usage hours, volumes, percentage of spontaneous breaths, respiratory rate, AHI, SpO2 and synchronisation details) including ResScan software allows clinicians to have detailed data for troubleshooting and monitoring patient progress as required. Some ResMed ventilators such as Stellar can also display live data (such as flow and pressure curves) as well as summary data on the device itself.
- Real-time therapy monitoring allows ideal titration of the patient, optimal follow-up, and adjustment of therapy settings as the disease progresses. 2
- ResMed’s Stellar 100 and 150 ventilators allow comprehensive real-time monitoring.
Quality of life considerations are also important for those with ongoing chronic conditions. 3, 4
- Whether powered by an internal battery or ResMed's external battery, the ResMed Power Station II (RPSII), an independent power sources helps patients to maintain their independence, encourages rehabilitation compliance and enhances quality of life.
Jean-Paul Janssens et al on behalf of the SomnoNIV Group. Nocturnal monitoring of home noninvasive ventilation: The contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax 2011; 66:438–445.