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AVAPS therapy & the chronic disease sufferer

Average Volume Assured Pressure Support (AVAPS) therapy technology¹ is designed to provide consistent tidal volume – e.g. volume of inhaled air – at the lowest minimum inspiratory pressure. AVAPS therapy maintains the low pressure required to achieve the prescribed tidal volume, with each and every breath. Patients can enjoy enhanced comfort and the confidence that the therapy is working effectively.

By monitoring and adapting pressure levels to the ebbs and flows of each breath and over time, hybrid mode AVAPS can be an effective therapy for chronic disease sufferers, whose disease progression and needs evolve. AVAPS can treat overlapping breathing syndromes, including treatment for hypo-ventilation¹ and OSA, regardless of the ventilation mode required.¹

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AVAPS: A low pressure therapy that supports patients with respiratory insufficiency issues due to chronic disease

With each breath

While other pressure therapies consider aggregate tidal volume over a period of time, AVAPS considers each breath. AVAPS measures patient tidal volume per breath, compares it to the target tidal volume, and compensates accordingly. An algorithm adjusts for cycling and compensates for leaks. Then the ventilator increases or decreases the pressure with each breath, in order to achieve the prescribed tidal volume consistently over time. This provides consistent tidal volume per breath while delivering the comfort and advantages of pressure support ventilation.²

The impact is real. Among obese patients with hypoventilation issues, AVAPS has been shown to be as effective as standard fixed bi-level pressure support (PS) ventilation accompanied by a strict protocolised setup. It has produced comparable improvements in nocturnal ventilatory control and daytime gas exchange, HRQL, daytime symptoms and daytime physical activity in obese patients. In short, AVAPS has been shown to work well as when a medical professional titrates the patient.^3,4

Raise the ventilation bar

AVAPS raises the ventilation bar because it lowers the bar – in terms of an ability to apply the lowest possible ventilation pressure to get the job done. It is adaptive therapy designed for comfort and compliance. And, studies have suggested that AVAPS provides beneficial physiological improvements, resulting in a more efficient decrease of PtcCO2 compared to BPV-S/T therapy alone ((For respiratory insufficiency patients diagnosed with Obesity Hypoventilation Syndrome).⁵

Treating patients with multiple comorbidities – including chronic respiratory issues ― requires a robust tool kit of solutions. The AVAPS adaptive approach to pressure therapy is one innovation among many at the disposal of care professionals. Tools and resources to educate and empower patients to track treatment progress, connect with care givers for support and advice, and help professionals proactively identify patients who may be struggling – these can all play a part in achieving a more effective approach to respiratory care.

Managing the airway

Airway management is another area where adaptability and automation are key. Ventilation features can help continuously monitor the airway can help keep it clear and open, at the lowest possible pressure, throughout the night. Again, the result is delivery of the lowest possible pressure, and comfort for the patient.

Author: Jim McKenzie, HRC Ventilation Product Manager, Philips Healthcare

¹BiPAP AVAPS only

²Windisch, Wolfram. "Average Volume-Assured Pressure Support in Obesity Hypoventilation." CHEST 130 (2006): 815

³With respiratory insufficiency patients diagnosed with Obesity Hypoventilation Syndrome

⁴Murphy, Patrick Brian, et al. "Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial." Thorax 67.8 (2012): 727-734.

⁵Murphy, PB Thorax thoraxjnl-2011-201081: Published Online First: 1 March 2012 doi:10.1136/thoraxjnl-2011-201081