Successful ventilation relies on improving gas exchange and reducing the work of breathing while keeping the patient comfortable. Maintaining patient-device synchrony and managing leak is critical to achieving this.
Ventilator asynchrony can cause significant discomfort, distress and poor clinical outcomes. One study estimates that 40% of non-invasive ventilation patients experience asynchrony in 10% or more of their breaths.1,2
A good device should help overcome this by:
- Monitoring and compensating for leak
- Accurately sensing the start and end of a patient’s inspiratory effort for triggering and cycling
- Responding quickly to reach and maintain the set pressure
- Offering flexibility of settings to accommodate pathological variations in the patient’s respiratory timing/pattern
Designed to identify changes to a patient’s breathing, where sensitivity to leak and patient–ventilator asynchrony is important, all our devices feature the following technologies to help you provide better clinical outcomes:
Vsync provides synchrony in the presence of leak
Acutely sensitive to a patient’s breathing, our Vsync algorithm rapidly compensates for any presence of leak by automatically adjusting the baseline flow. And because it can also accurately estimate respiratory flow and tidal volume, it is beneficial for circuits with intentional leak. All this is achieved while maintaining reliable triggering and cycling, and set pressures.
TiControl™ helps the patient to exhale
TiControl allows clinicians to limit the minimum and maximum amount of inspiratory time to suit a patient’s condition. For COPD (chronic obstructive pulmonary disease) patients, whose respiratory flow is restricted, and who have difficulties exhaling, a shortened Ti Max (maximum time a patient can spend in inspiration) can prevent late cycling to expiratory pressure, which helps provide a better match to the patient’s ideal inspiratory time.
Five adjustable levels of trigger and cycle sensitivities
By determining the timing and level of effort at the beginning and end of each breath, you can fine-tune sensitivity settings to match a patient’s spontaneous breath cycle.
For Lumis™ and Astral™ ventilators, the default Medium setting will be appropriate in most cases.
Major therapy parameters can be pre-programmed in some of our ventilators to help you set up. (E.g. By choosing ‘Obstructive Lung’ from the Pathology Defaults for patients with COPD using a Stellar™ ventilator.)
However, having the option to fine-tune trigger and cycle sensitivities allows further customisation at the beginning and end of each inspiration.
This helps reduce the patient’s work of breathing, and optimise patient–ventilator synchrony.
Controllable rise and fall times allow you to optimise the patient’s work of breathing, comfort and synchrony.
Rise time is the time it takes for the ventilator to reach the set inspiratory pressure after triggering; Fall time is the time it takes to reach the set expiratory pressure after cycling.
Rise and fall times can be tailored to suit different individuals and their conditions. Faster rise and fall times ensure rapid transitions, while slower times provide a more gradual transition.
For a COPD patient, a faster rise time setting can help the lungs fill quickly.
As well as the technologies featured above, ResMed’s ventilators provide a range of ventilation modes:
Traditional modes include:
- CPAP (Continuous Positive Airway Pressure) mode—where a fixed pressure is delivered.
- S (Spontaneous) mode—the device senses the patient’s breath and delivers IPAP in response to an increase in flow, and cycles into EPAP at the end of inspiration. The breath rate and respiratory pattern will be determined by the patient’s breathing.
- ST (Spontaneous/Timed) or PS (Pressure Support) mode—the device augments any breath initiated by the patient, but will also supply additional breaths should the patient’s breath rate fall below the clinician's set ’backup’ breath rate.
- T (Timed) mode—the fixed breath rate and fixed inspiration time set by the clinician are supplied regardless of patient effort.
- PAC (Pressure Assist Control)—the inspiration time is pre-set in PAC mode. There is no spontaneous/flow cycling. The inspiration can be triggered by the patient when the respiratory rate is above a pre-set value, or time-triggered breaths will be delivered at the backup breath rate.
ResMed’s iVAPS mode
With the introduction of iVAPS mode, an intelligent back-up rate (iBR), and auto-adjusting AutoEPAP feature, we can help set a new standard in personalised and responsive ventilation for COPD patients. Together, we call these new technologies IntelligentAir.
iVAPS delivers auto-adjusting pressure support
Targeting each patient’s unique alveolar ventilation, iVAPS mode auto-adjusts the pressure support to maintain that target, and stabilise the patient’s breathing.
iVAPS automatically adapts to the patient’s changing needs by constantly monitoring their actual ventilation and respiratory rate in relation to their target ventilation and respiratory rate.
iBR inserts backup breaths only when needed
A feature of iVAPS, the intelligent Backup Rate (iBR) provides backup breaths only when needed, to allow maximum opportunity for spontaneous breathing.
Giving patients maximum opportunity to spontaneously trigger the ventilator, iBR shifts between two limits: the target patient rate, and its background frequency, which is two-thirds of the target rate.
The importance of targeting alveolar ventilation
Some ventilation modes target tidal volume (or minute ventilation), without taking into account the anatomical dead space in the patient’s airways. What’s different about ResMed’s iVAPS mode is that it targets alveolar ventilation, which represents the most accurate measure of a patient’s lung and respiratory capacity.
Because iVAPS takes into account both tidal volume and respiratory rate, by targeting alveolar ventilation, the effect of respiratory rate variation on ventilatory support can be better controlled.
AutoEPAP addresses upper airway obstructions
Complementing iVAPS, the optional AutoEPAP feature helps address partial and full obstructions to maintain upper airway patency.
AutoEPAP responds to upper airway obstructions by auto-adjusting expiratory pressure according to the severity of the event.