Introducing Auto-EPAP, the latest update designed to improve the quality of ventilation by addressing partial and full obstructions of the upper airways to maintain upper airway patency.
Auto-EPAP exemplifies Breas’ product core values of comfort and simplicity.
Recognising that each patient will respond differently to treatment, being able to control speed of increase and decrease of their EPAP pressure will help deliver maximum comfort and optimize treatment outcome. Clinicians will benefit by being able to leverage Auto-EPAP across all pressure modes as well as Target Volume mode (TgV), making it suitable for both for titration and for treatment at home.
Over recent years, increasing numbers of patients with neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS) and other forms of chronic respiratory failure are using non-invasive ventilation (NIV) for respiratory support.
Optimization of settings for NIV, including determination of fixed expiratory positive airway pressure (EPAP), often requires time-consuming manual titration by experts*.
/ Orr JE et al, Respirology. 2019 Dec;24(12):1204-1211
Using Auto-EPAP
During the NIV titration process, the upper airway pressure support needs changing over time, an automatically adjusting expiratory positive airway pressure (Auto-EPAP) algorithm may offer advantages over a manually set fixed EPAP.
Respiratory effort followed by an absence of flow for a minimum of 10 seconds, is detected as an obstructive event. The device will increase the EPAP after the event in function of the settable EPAP Step (0.5-1.0-1.5-2.0 cmH2O) (Fig 1).
If a hypopnea is detected (flow reduction
below 70% of baseline over a 10 second duration), the EPAP pressure will increase during the event. The goal is to prevent a full airway collapse by increasing the EPAP (Fig 2).
Once the device detects a state of normal breathing the pressure will decrease with 0.5 cmH2O. The Relax time can be set from 2 to 12 minutes with a resolution of 1 minute (Fig 3).
Fig 1: EPAP behaviour in case of an obstructive apnea.
Fig 2: EPAP behaviour in case of obstructive hypopnea.
Fig 3: EPAP decrease during normal breathing.
Settings
| Setting | Description | Range |
|---|---|---|
| Auto-EPAP | (De)activate Auto-EPAP | On / Off |
| Max EPAP | Maximum EPAP allowed | 2 - 20 cmH2O |
| Min EPAP | Minimum EPAP allowed (= start value) | 2 - 20 cmH2O |
| PS | Constant Pressure Support above actual EPAP (PIP = EPAP+PS) | 2 - (max pressure -2 cmH2O) |
| Pressure Limit | Absolute Maximum Pressure that can be reached | 4 - max pressure |
| Max PS | Maximum Pressure Support allowed in TgV | 2 - (max pressure -2 cmH2O) |
| Min PS | Minimum Pressure Support allowed in TgV | 2 - (max pressure -2 cmH2O) |
| EPAP Step | Incremental Pressure step used to increase EPAP | 0,5 - 1,0 - 1,5 - 2,0 cmH2O |
| Relax Time | Period of normal breathing after which EPAP will decrease | Off, 2 - 12 min |