How do I guarantee ventilation efficiency ?
How do I ensure tolerance to ventilation ?
How do I know the system is reliable? Etc…
Respironics BiPAP
Efficiency
Comfort
Safety
Versatility
Prediction
How do I achieve an optimised patient/ventilator Synchronisation?
How do I guarantee ventilation Efficiency?
Respironics Technology and Know How
Efficiency
Comfort
Safety
Versatility
Prediction
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”
• AJRCCM 2001 : “Noninvasive Ventilator Triggering in Chronic Obstructive Pulmonary
Disease”
• Chest 2005 : “Performance Characteristics of 10 Home Mechanical Ventilators in PressureSupport Mode”
⇨ 2003: Respironics introduced AVAPS for improved ventilation comfort and efficiency
without compromise
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
Flow
Responds to extra flow demand (225LPM at 25cmH2O)
Compensates for most leaks
Reduces respiratory work
Pressure
Blower
Air Filter
Patient
Circuit
Airflow Sensor
Exhaust Proportional
Valve
Ambient Air
Respironics BiPAP Ventilators
BiPAP Harmony and BiPAP Synchrony
 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
250
200
Flow (LPM)
 Same Technology: BiPAP
‐ Blower works at a constant speed
‐ The valve controls the flow provided
by the blower
‐ Digital Auto-TRAK Sensitivity
150
100
50
0
24
25
26
27
28
Pressure (cmH2O)
29
30
« Unlike manually controlled triggers,
Auto-TRAK does the work for you »
Characteristics
‐ Automatic inspiratory trigger and expiratory cycle
‐ Leak compensation over 60LPM
‐ Leak estimation to calculate Vte at 15% accuracy
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
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
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
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”
Chest 2005 : “Performance Characteristics of 10 Home Mechanical Ventilators in PressureSupport Mode”
How do I set ventilation parameters?
How do I adapt settings to patients’ needs?
Ventilation Modes & Settings
Efficiency
Comfort
Safety
Versatility
Prediction
« 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
BiPAP Synchrony / BiPAP Harmony
Features
Synchrony
Harmony
CPAP – S – S/T – PC – T
AVAPS
Pressure up to 30 cmH2O
CPAP – S – S/T
Pressure up to 30 cmH2O
Monitoring
Pressure
MinVent – Vte – RR – Leak
Pressure
Alarms
Apnea
Disconnection
Low minute ventilation
Low tidal volume (AVAPS)
Apnea
Disconnection
Encore Pro / Stardust II / SmartCard
Integrated Humidifier
Battery (7hrs autonomy at 20/4 cmH2O)
Encore Pro / Stardust II / SmartCard
Integrated Humidifier
Battery (7hrs autonomy at 20/4 cmH2O)
Modes
Tools
Operational Characteristics
Modes Description
Patient inspiratory and
expiratory efforts
Pressure
IPAP
Ti Patient
Spontaneous
EPAP
T
Pressure
IPAP
Spontaneous
Timed
EPAP
S
Ti Patient
60/RR
T
Ti Machine
S
Ti Patient
Ti max
T
Operational Characteristics
Mode Description
Pressure
IPAP
Ti Machine
Ti Machine
Ti Machine
Timed
EPAP
T
Pressure
IPAP
Ti Machine
Pressure Control
Ti Machine
Ti Machine
EPAP
60/RR
T
Respironics Ventilation Modes
S mode
S/T mode
P/C mode
T mode
 IPAP
 EPAP












Spontaneous breaths
IPAP
EPAP
RR
Ti
Spontaneous
breaths with back
up respiratory rate
IPAP
EPAP
RR
Ti
Ti fixed for every
breath
Patient can
trigger to
inspiration
IPAP
EPAP
RR
Ti
Each breath is
controlled
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
AVAPSTM Suggested Settings
AVAPS Settings
1.
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
2.
Set IPAP Limits
IPAP max = 25 to 30 cmH2O
depending on patient pathology
and
IPAP min = EPAP + 4 cmH2O
Synchrony Screen
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
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
Easily Set the Ventilation on our BiPAP
Palm Pilot remote control
SleepLink
BiPAP Harmony
BiPAP Synchrony
Computer with PC Direct software
Easily Set the Ventilation on our BiPAP
Palm Pilot remote Control
PC Direct Software
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
100% fit,100% of the time
Optimize comfort and
drive therapy acceptance
of new patients
Replaces silicone
masks of patients
already on therapy
A solution to mouth
breathers and acute NIV
patients
Smaller and lighter masks for patients who are looking for
comfortable alternatives. Comfort with Style.
Efficiency
Comfort
Prediction
Safety
Versatility
BiPAP Harmony
Digital Auto-TRAK Algorithm
BiPAP Technology
Encore Pro
Compact & light
Integrated Humidifier
Stardust II
Battery Pack
BiPAP Synchrony (featuring AVAPS)
Digital Auto-TRAK Algorithm
BiPAP Technology
Compact & light
Integrated Humidifier
Encore Pro
Stardust II
Patient alarms
& monitoring
Ventilation modes
& settings
Battery Pack
AVAPS support function