BiPAP AVAPS
BY
AHMAD YOUNES
PROFESSOR OF THORACIC MEDICINE
Mansoura Faculty of Medicine
BiPAP AVAPS
It's the only way of ensuring the delivery of
targeted tidal volume for noninvasive
ventilation patients.
Short-hand for "Average Volume Assured
Pressure Support," AVAPS sets the
standard in noninvasive ventilation.
The exclusive AVAPS algorithm automatically
adjusts pressure support to meet changing
patient needs while maintaining a target tidal
volume.
BiPAP AVAPS
Warnings
» You should read and understand this entire manual
before using the device.
» The device is not intended to provide your total
ventilatory requirement.
» The prescription must only be adjusted by a trained
home care provider.
» When using a breathing circuit that contains a mask
with an integrated exhalation port or a circuit with a
separate exhalation device, do not tape, seal, block
the vent openings.
» If oxygen is used with the device, the oxygen flow
must be turned off when the device is not in use.
» Oxygen should not be used while smoking or in the
Warnings
» Do not use the device if the room temperature is above
(35° C). If the device is used at room temperatures above
(35° C), the temperature of the airflow may exceed (41° C),
which could cause irritation to your airway.
» Do not operate the device in direct sunlight or near a
heating appliance because these conditions can increase
the temperature of the air coming out of the device.
» When the device is used with a humidifier, position the
humidifier so that the water level in the humidifier is lower
than you, and the humidifier is on the same level or lower
than the device.
» Do not attempt to wear your mask without the device
turned on. Doing so could result in CO2 rebreathing.
Rebreathing of exhaled air for longer than several minutes
can, in some circumstances, lead to suffocation.
Warnings
» If you notice any unexplained changes in the performance of
the device, if it is making unusual or harsh sounds, if it and/or
the power supply has been dropped or mishandled, if the
enclosure is broken, or if water has entered the device,
discontinue use and contact your home care provider.
» Repairs and adjustments must be performed by Respironics
authorized service personnel only. Unauthorized service could
cause injury, invalidate the warranty, or result in costly damage.
» Periodically inspect electrical cords, cables, and the power
supply device for damage or signs of wear.
» To avoid electrical shock, unplug the device before cleaning.
Cautions
» The device may only be operated at temperatures
between (5° C) and (35° C).
» A properly installed, undamaged reusable foam
inlet filter is required for proper operation.
» Do not immerse the device or allow any liquid to
enter the enclosure or the inlet filter.
» Condensation may damage the device. Always
allow the device to reach room temperature before
use.
Intended Use
The BiPAP AVAPS device is intended to provide
noninvasive ventilation for pediatric patients 7 years
or older > 18.2 kg and adult patients >30 kg with
respiratory insufficiency or obstructive sleep apnea.
This device may be used in the hospital or home .
• NOTE: The device is to be used only on the
instruction of a trained health care professional.
Who potentially benefits from AVAPS™
technology?
• Restrictive patients benefit because AVAPS™ provides the
comfort and leak compensation of a pressure mode and the
safety of a guaranteed volume.
• Obese hypoventilation patients benefit because the
algorithm compensates for changes in body position and
maintains ventilation.
• COPD patients benefit because AVAPS™ achieves a
combination of ventilation comfort and efficiency without
compromise. The algorithm applies the right pressure at the
right time.
Average Volume Assured Pressure
Support in Obesity Hypoventilation:
• Randomized Cross-Over Trial
This study conducted on 10 patients with obesity
hypoventilation syndrome (OHS) showed that
BiPAP® S/T substantially improves sleep quality
and specific aspects of the quality of life; the
addition of AVAPS further improves the decrease of
PtcCO2.
Average Volume Assured Pressure Support (AVAPS) for
Pressure-Controlled Ventilation (Bi-level Therapy with a
BiPAP®AVAPS™ System)
• Three clinical cases of patients with chest deformities
where the application of conventional ventilation
methods (two patients using pressure-controlled
ventilation and one using volume-controlled ventilation)
did not produce satisfactory results.
• After switching to AVAPS, results included an increase
in average SpO2, reduction of pCO2 and an improved
acceptance of therapy compared to previously used
ventilation methods.
• AVAPS technology makes it possible to combine the
comfort and leak compensation of a pressure mode, and
the safety and efficiency of an adaptable pressure
support to fit current physiological conditions.
Short-Term Efficacy of Spontaneous AVAPS (Average
Volume Assured Pressure Support) Mask Ventilation in
Patients with Hypercapnic COPD
• The aim of this study was to evaluate the short-term clinical
efficacy of spontaneous mask AVAPS versus PS ventilation
in patients with hypercapnic chronic respiratory insufficiency.
• The primary end-point was to assess changes in blood
gases whereas the secondary endpoint was to record the
patient's comfort under these two different modalities.
• Results from 10 stable COPD patients: PaCo2 and patient
comfort have been significantly improved
• Short-term AVAPS mask ventilation is feasible and effective
in stable COPD patients with hypercapnia.
Contraindications
1-The device should not be used if you have severe
respiratory failure without a spontaneous respiratory drive.
2-If any of the following conditions exist:
• Inability to maintain an open airway or adequately clear
secretions
• At risk for aspiration of gastric contents
• Diagnosed with acute sinusitis or otitis media
• Allergy or hypersensitivity to the mask materials where
the risk from allergic reaction outweighs the benefit of
ventilatory assistance
• Epistaxis, causing pulmonary aspiration of blood
• Hypotension
Precautions
» Immediately report any unusual chest discomfort,
shortness of breath, or severe headache .
» If skin irritation or breakdown develops from the
use of the mask, refer to the mask instructions for
appropriate action.
» The following are potential side effects of
noninvasive positive pressure therapy :
» —Ear discomfort
» —Conjunctivitis
» —Skin abrasions due to noninvasive interfaces
» —Gastric distention (aerophagia)
Rise time
S/T Mode
Mode summary
AVAPS averages Vt and changes PS value
gradually. This occurs over several minutes.
The rate of change is slow , so the patient is not
aware of breath to breath change.
AVAPS features
• As the patient effort decrease ,AVAPS automatically
increase PS to maintain the target Vt. The IPAP
level will not rise above IPAP Max. even if the target
Vt is not reached. Conversely, as the patient effort
increase , AVAPS will reduce PS , IPAP will not fall
below IPAP Min. even if the target Vt is exceeded .
• If the IPAP Max. is reached and the targeted Vt is
not achieved , the low tidal volume alarm is
activated.
Bi-Flex comfort feature
Ramp
Respironics PR System One
• Once the device is powered, the home screen appears
(it is a large box on the screen with four little boxes you
choose from by turning the control wheel).
• Turn the wheel to toggle between the 4 options and
highlight "setup". Once setup is highlighted press and
hold both the control wheel and ramp button on the
device for at least 5 seconds. You will hear a double
beep and the provider mode screen will appear.
• Also, you should remove the smart card prior to making
adjustments, otherwise it will revert to the previous
settings.
Respironics PR System One
• Scroll down by turning the knob.
Make a selection by pressing the knob down, which
will activate the option.
• Change the setting by turning the knob again (for
instance, from a 5 minute to 10 minute ramp time).
Press knob to lock that choice in.
AVAPS suggested settings
»
1. Set the target tidal volume to 8 ml/kg of
ideal weight.
» 2. Set IPAP limits
Max: 25 cm H20 depending on patient
pathology
Min: EPAP + 4 cm H20.
» 3. Set respiratory rate 2-3 BPM below
resting respiratory rate.
Ideal body weight
• Estimated ideal body weight in (kg)
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
• Estimated adjusted body weight (kg)
If the actual body weight is greater than 30% of the
calculated IBW, calculate the adjusted body weight (ABW):
ABW = IBW + 0.4(actual weight - IBW)
• The IBW and ABW are used to calculate medication dosages
when the patient is obese.
• This formula only applies to persons 60 inches (152 cm) or taller.
» 4.
Set inspiratory time.
» 5. Adjust rise time for patient comfort.
The recommended % IPAP time is usually between
30% and 40%. the default inspiratory time on nppv
devices is commonly 1.2 seconds. (level a consensus).
• A shorter inspiratory time (%IPAP time of approximately 30%)
may be useful in patients with concurrent obstructive airways
disease (especially at higher respiratory rates) to allow
adequate time for exhalation.
• A longer inspiratory time (%IPAP time of approximately 40%)
may be useful in patients with restrictive disease such as
RTCD (decreased respiratory system compliance). (level a consensus).
Suggested Protocol
• Set target tidal volume to 110% of displayed patient
tidal volume in the S/T mode or 8 cc per kg of ideal
body weight.
• IPAP Max = 25-30 cm H20
IPAP Min = EPAP + 4 cm H2O
• *Respironics does not provide medical advice.
• This protocol is a suggested protocol only and is
not intended to replace or modify your institution's
established protocols.