Philips Technologies

Philips Technologies

• Digital AutoTrak• Digital AutoTrak sensitive• AVAPS• AVAPS rate• AVAPS-AE

Digital AutoTrak (DAT)

Components of DAT

A. Recognizes and compensates for system leaks 1. Leak ToleranceB. Provides 2 methods of inspiratory Trigger 2. Volume Trigger 3. Shape TriggerC. Provides 4 methods of expiratory cycling 4. Spontaneous Expiratory Threshold (SET) 5. Shape Trigger/Cycle 6. Flow Reversal 7. Maximum IPAP time

1. Leak Tolerance

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1 = Increase in flow & stabilizes most part of the inspiratory phase

2 = Decrease in flow & stabilizes most part of the expiratory phase

= Original Baseline/Beginning of inspiration/End of expiratory cycle

= Change in leakage flow/New Baseline Flow

Inspiratory Triggering

2. Volume Trigger

3. Shape Trigger

Patient Flow = Total Flow- Circuit Leak

Shape Signal (Appears as a shadow image of the patient actual flow)

The shape trigger functions as a “sensitivity threshold” for inspiration and expiration

Expiratory Cycling

4. Spontaneous Expiratory Threshold

Actual FlowThe slope of the SET is calculated at the beginning of the breath and signal rises in proportion to the inspiratory flow rate of each breath

When the SET signal crosses the flow signal, EPAP is triggered

5. Shape Trigger/Cycle

The shape signal also functions as a “sensitivity threshold” for Expiration, when patient flow crosses the shape signal , it cycles into EPAP

6. Flow Reversal

During flow reversal, the unit in the process Of cycling into EPAP when the leak occurs

Flow reversal does not allow trigger to IPAP without returning to EPAP. This keeps “breath stacking” from occurring

7. Maximum IPAP Time

DAT Components Modes

1. Leak Tolerance All Modes

2. Volume Trigger All Modes (except T & CV)

3. Shape Trigger All Modes (except T and CV

4. SET All Modes (except T, CV, AC & SIMV)

5. Shape Cycle All Modes (except T and CV)

6. Flow Reversal All Modes

7. IPAP Time S, S/T, T, PC

Bottom line!!!The DAT detects and compensates for unintentional leaks in the system and automatically adjusts trigger and cycle algorithms to maintain optimum performance in the presence of leaks

DAT Sensitive

Sensitive Auto-Trak is an enhancement to the DAT algorithm that improves patient and machine synchrony for patients with minimal respiratory effort. DAT refines the baseline trigger and cycle sensitivity thresholds.

Hybrid Modes

1. AVAPS

2. AVAPS-AE

What are hybrid modes?

Pressure Support Ventilation modes with targeted volume delivery

What is AVAPS?

• Average Volume Assured Pressure Support

• Available in S, S/T, PC, and T modes (Not a standalone mode!!!)

• It maintains tidal volume (VT) equal to or greater than the target volume setting by automatically controlling the PS

AVAPS rate

• Allows the adjustment of the maximum rate at which PS automatically changes to achieve the target volume

AVAPS Speed per Device

Fixed 2.5 cmH2O / min

0.5 to 5 cmH2O / min

1 to 5cmH2O / min

How does AVAPS Work? AVAPS automatically adapts pressure support to patient needs to guarantee an average tidal volume.

Target Vt

EPAP

IPAP

± 1 to 3 cmH2O over 1 min

IPAP min

IPAP max

Main Settings:

• Can be accessed in S, S/T, PC and T modes• AVAPS (set based on IBW 6-8ml/kg)• IPAP max• IPAP min• EPAP• RR• Ti

AVAPS-AE

What is AVAPS-AE?

AVAPS-AE is a auto-titration mode of noninvasive ventilation designed to better treat respiratory insufficiency patients (OHS, COPD and NMD) in the hospital and homecare environments

Components of AVAPS-AE

• AVAPS

• Automatic EPAP (AE)

• Auto RR

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AVAPS AE settings

EPAP

Target Vt

IPAP PS min

PS max

AVAPS-AEMaintaining Tidal volume and Airway patency

EPAP min

EPAP max

Resistance

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Theory of Operation

Upper Airway Resistance

Device Pressure

P search

crit

Ptherapy

P searchopt

Illustration courtesy of Krames Medical Illustration.

AVAPS-AE: Auto EPAP proactive analysis

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Popt – Optimal Pressure Search

(High Pressure Search)

EPAP

P opt

P opt

P therapy

P therapy

Critical Pressure Searches

(Low Pressure Search)

P crit

P crit

P therapy

EPAP

P crit

P therapy

Popt

Pcrit

Auto EPAP Proactive Analysis

Pther

Popt

Pres

sure

Resistance

Pcrit

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P opt

SET BRUsed for the rest of the night

AVAPS-AEAuto Backup rate

121

2

3

4

567

8

9

10

11

1st hour

50 breaths Sliding window

BR continually Updates

1h

BR set

15

30

45

560

BR=Actual Rate minus 2

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Auto backup rateM

ovin

g br

eath

rate

Minimum autobackup rate

Spontaneous breaths

Time 50 breaths

10

Calculated spontaneous rateTarget auto

backup rate

Targeted auto backup rate is 2 bpm below avg. spontaneous

rate

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Bpm

Auto backup rate

Spontaneous BreathsTimed Breaths

Target auto backup rate

10 Auto backup rate buffer zone

The auto backup rate is buffered by spontaneous triggers to promote synchrony with

the device

• The buffer is reduced or eliminated by timed triggers.

• The patient will be guided back to the targeted backup rate

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Bpm

M

ovin

g br

eath

rate

Time (Night time session)

Bottom line: AVAPS-AE is an “auto-titrating” BIPAP mode that will respond to:1) Hypoventilation (AVAPS)2) Airway Closure (AE)3) Inconsistent Respiration and /or Apnea (Auto RR)