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  • Performance Parameters(2) Auto CPAPDynamic pressure adjustment in time
    Different patients need different airway pressure support ; 
    The same patient, different stages of sleep (deep sleep, light sleep, rapid eye movement), different states before going to sleep (drinking, fatigue), different types of sleep spnea (central, obstructed, mixed) will require different pressure support.
    Timely adjustment of pressures according to patients and different states;
    The apnea index is reduced to below five. There is no nighttime suffocation and awakening.
    Performance Parameters(1) Auto CPAPAuto CPAP:Stable Pressure 

    If CPAP pressure output unstable, it can cause pressure fluctuations in the mask. The CPAP machine can continuously adjust the motor speed by sensing pressure fluctuations, keep the pressure inside of mask stable.

    The easy way to test a CPAP pressure is: connect a pressure meter to the mask, set the pressure to 10cmH2O, and breathe naturally (do not breathe deeply) with the mask. Qualified machine: pressure fluctuation within ±1cmH2O, good machine within ± 0.5cmh2o. If more than ±2cmH2O, that CPAP machine is unqualified.
  • CPAP design
    1. Steady pressure, gentle airflow
    2. Quiet
    3. Recognize central and obstructive respiratory events

    BIPAP design
    1. Strong ability to adjust pressure
    2. Large air flow
    3. Good synchronization (accurate expiratory and inspiratory judgment)
    4. High safety factor
    5. Better motors, sensors,operational capability, automatic control algorithms, etc
  • Operation Skills for CPAP
    The Key for first time use CPAP/BIPAP: wear the mask properly.
     Process: (wear the mask before use the machine)

    1. Introduce nasal/ full mask structure and function; especially vent hole;
    2. Clear introduction: adjust the tightness of wearing;
    3. Wearing method: slightly tight at below headgear, slightly loose at above headgear;
    4. Do not connect to the machine, let user lie down( or half lying) only wear the mask to breath more than 15 minutes ;
    5. Practice proper use of nasal/full mask in front of a mirror.
    The main factors leading to failure treatment 
    1. Nasal/full mask
    Failure to wear the mask resulted in severe air leakage and insufficient pressure inside the mask, The tightness of the mask is based on the principle of no air leakage.
    2. Improper adjustment of pressure parameters
    3. Others: poor machine performance, large pressure fluctuations in the mask; improper adjustment of the degree of humidity, etc.
    The principle of setting CPAP pressure for the first time
    Pressure can be adjusted a little higher, higher pressure is better than lower;

    Auto CPAP Parameter Setting: 
    1. Determine the starting pressure
    User lies down, the pressure starts from 4cmH2O (higher for heavier patients), Then increase the pressure gradually . The pressure that the patient feels better is set as the initial pressure.The default parameter is 6cmH2O for women and 8cmH2O for men.
    2. When the treatment pressure is not clear, the minimum pressure can be set as the initial pressure; The maximum pressure is determined by the severity of the patient (referring to the AHI value),  for male patients (8-13) and for female patients (6-11).
    3. If the patient's treatment pressure is known, the minimum pressure can be set to P-2 (if less than the initial pressure, then set initial pressure as minimum pressure);  the maximum pressure can be set to P+2. For example, if the titration pressure is 10, the pressure range can be set to: 8-12 cmH2O. 
    Service after using the machine
    Follow-up service after first night use.
    If the machine is not well worked, patients often have emotions(some people think that the CPAP is not useful),we must help the patient to solve the problem.
    Download data for analysis


    Common use failures:
    1. Nasal/full mask has fallen off;
    2. The patient is awaked by large air leakage, check the machine records of air leakage; 
          The above 2 points are caused by insufficient pressure or air leakage .
    3. Feel dry in the morning;
    4. Feel bloated in the morning.
    Common Cause Analysis
    Nasal/full mask has fallen off: caused by insufficient pressure or air leakage,The patient pulled off his mask because he was suffocating.
    The patient is awaked by insufficient pressure or air leakage:the patient often has a rapid heartbeat due to suffocation.  patients will blame the machine make him uncomfortable. Such patients may consider recommending BIPAP machine.
    Feel mouth dry in the morning: common reasons are insufficient pressure or air leakage, the mouth is dry due to the rapid flow of air from the mouth. There are also a few that are caused by insufficient humidification. 
    Dizziness after used machine few days:Many patients with hypertension or diabetes did not reduce or stop medicine, resulting in hypotension or hypoglycemia. Therefore, for these patients, daily monitoring of blood pressure and blood sugar is necessary. Follow physician's advice to reduce or stop the medicine.    
    Feel bloated in the morning:The pressure is too high and the airflow enters the stomach
    Too much air leakage
    Air leakage in mouth area→ Use full face mask or lower jaw belt
    Change mask size and headgear adjustment

    Pharyngeal dryness
    Constant temperature humidifier
    Warming humidifier

    Skin irritation/injury
    Adjust nasal/full mask size and tightness
    Use a softer mask
    Intermittent use
  • Key index for the first use of the machine: tidal volume above 500mL and stable respiratory frequency BPM(breath per minute).
    Key index
    Tidal volume                  >500mL
     BPM Normal                 8~20bpm
     Minute volume 8~10L
    SpO2 >95%
    PCO2                             35~45mmHg(4.67~6kPa)
    PetCO2                           5%~8%
    The initial pressure adjustment parameter (if the patient used BIPAP before, keep the original parameters ),  mask usage is the same as CPAP 
    IPAP 16cmH2O
    EPAP 4cmH2O
    Backup Rate 16 Bpm
    I/E Rate 35%
    Inspirate Trigger 3    (Range:1 – 5, '1' is the most sensitive)
    Expirate Level 3    (Range:1 – 5, '1' is the most sensitive)
    Inspirate Sensitivity 3    (Range:1 – 5, '1' is the most sensitive)
     
    Check the pressure  and airflow waveform on the screen to see the effect.
    On the home page. The interface of the device is shown as follows: you can press up and down buttons to switch the screen interface.

    Interface-DS Series-1Interface-DS Series-2
     


    Difficulty in breathing
    Reasons:
    • Nervous, fear to wear nasal/mask 
    • Overbreathing
    • Hold breath too early
    • EPAP is too high, affecting hemodynamics
    • Insufficient pressure support
    • There may be undetected contraindications, such as an undrained pneumothorax
    Solutions:
    • Strengthen patient counseling and training
    • Adjust the proper EPAP
    • Adjust the proper pressure support
    • Careful examination of the contraindications

    Low SpO2
    Reasons:
    • EPAP too high or too low
    • Oxygen source problem
    • FIOZ too low
    • Excessive secretions, poor discharge
    • Air leakage is too large
    • Inadequate treatment time
    Solutions:
    • Adjust EPAP and IPAP.
    • Check oxygen source
    • Increase inhaled oxygen flow
    • Sputum suction
    • Adjust nasal/mask wear and reduce air leakage
    • Extend treatment time

    High CO2
    Reasons:
    • Insufficient pressure support
    • Air leakage too low
    • EPAP too low
    • Excessive secretions, poor discharge
    • Inadequate treatment time
    • COPD combined OSA, nightime EPAP level is not adjusted 
    Solutions:
    • Increase pressure support
    • Increase air leakage
    • Open all openings of mask or adjust mask loose properly.
    • When IPAP<15cmH2O , use platform exhaust valve
    • Adjust EPAP to offset PEEPi and reduce repetitive breathing
    • Sputum suction
    • Extend treatment time
    • Adjust nighttime EPAP and IPAP level 
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Hunan Jintai Hardware and Machinery Co.,Ltd

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