Epap/Peep; Trigger/Cycle Sensitivities - ResMed C28173 Manual

248476r4.book Seite 56 Freitag, 28. Oktober 2011 3:10 15
TiControl calculation guide
The following table is a guide to selecting the Ti Max and Ti Min values that best correspond to
the patient's respiratory rate (ideally while using the ventilator at rest).
Patient breaths
per min
10
15
20
25
30
35
40

EPAP/PEEP

The appropriate setting of PEEP (or EPAP) is fundamental to modern ventilation practice, across
most modes of therapy. Examples of its use include:
Recruiting and/or maintaining lung volume, aiding gas exchange, improving lung compliance,
•
or minimising lung injury.
In obstructive lung disease—to offset intrinsic PEEP , to reduce work of breathing, and/or
•
maximise effective triggering.
To splint open or stabilise the upper-airway during sleep.
•
For nocturnal ventilation, a starting pressure of 5 cm H
indication of symptoms such as daytime sleepiness, obesity, an anatomically narrow airway or
neuromuscular disease, or pressure support frequently reaching the maximum level, an
additional 1 – 3 cm H
Stellar provides monitoring—such as optional integrated SpO
to assist with titrating EPAP/PEEP in order to maintain upper airway patency. Evidence of
desaturation or flow limitation may lead to EPAP/PEEP adjustment.

Trigger/cycle sensitivities

High trigger sensitivity decreases the flow threshold necessary for the device to move from
EPAP to IPAP, making it easier for the patient to trigger. So, for example, for patients who have
insufficient inspiratory effort (flow), set the trigger setting to 'High' or 'Very High' to increase
sensitivity to patient effort. So the patient needs to exert less effort to trigger the device.
Less sensitive settings—'Low' and 'Very Low'—provide flexibility for patients prone to
auto-triggering, caused by restrictive lung diseases and cardiogenic artefact. Cardiogenic
artefact refers to impulses within in the respiratory flow signal that originate from cardiac
activity rather than respiratory effort. It can result in false triggering, if the impulses exceed the
trigger flow threshold.
High cycle sensitivity will result in an earlier transition from IPAP to EPAP and low cycle
sensitivity will delay this transition. For example, for patients who cannot maintain inspiratory
flow, or who complain of having their breath 'cut off', set the cycle setting to 'Low' or 'Very Low'
which will delay the transition from IPAP to EPAP. This will tend to prolong inspiratory time.
For characteristic data, see "Technical specifications" on page 63.
56
T = I:E = 1:2
tot
60 ÷ breaths (eg, normal
per min lungs)
(sec)
6 2
4 1.3
3 1.0
2.4 0.8
2 0.7
1.7 0.6
1.5 0.5
O may be helpful.
2
I:E = 1:1
(eg, restrictive lungs) (eg, obstructive
Ti Min Ti Max
1.0 2.5
1.0 1.7
0.8 1.5
0.7 1.2
0.6 1.0
0.5 0.8
0.5 0.7
O is recommended. If there is any
2
and high resolution flow data—
2
I:E = 1:3
lungs)
Ti Max
1.5
1.3
1.0
0.8
0.7
0.7
0.7