The Stellar 150® (ResMed Inc., Sydney, Australia) was used for both S/T mode and VAPS mode for all patients. This NIV device was previously provided to all patients by a centralized Ventilator Equipment Pool in Ontario, Canada, as per standard clinical care prior to data collection for the study. NIV settings were titrated to optimize the control of SDB and patient-machine synchrony. The titration studies were performed by two experienced respiratory therapists (DM, AH) that are also trained sleep technologists. The RTs were present throughout the entire night of the PSG. The initial starting settings for the VAPS mode titration studies were informed based on the recommended settings for standard NIV (i.e. S/T mode).
Stellar 150
Manufactured by Resmed
Sourced in Australia
The Stellar 150 is a lab equipment product designed for clinical use. It serves as a ventilator device.
Automatically generated - may contain errors
5 protocols using stellar 150
1
Non-Invasive Ventilation Titration Protocol
2
Ventilator Comparison: Hospital vs. Home Use
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A total of nine ventilators were studied, two considered for hospital use (V60, Philips Respironics, Murrysville, Pennsylvania and Carina, Dräger, Lübeck, Germany) and seven ventilators for home use: Vivo 40 and Vivo 50 (General Electric, Mölnlycke, Sweden), Stellar 150 and Astral 150 (ResMed, North Ryde, Australia), (3) Trilogy 202 (Philips Respironics, Murrysville, Pennsylvania), (4) Puritan Bennett (PB) 560 (Covidien, Mansfield, Massachusetts) and Prisma Vent 30 (Weinmann, Hamburg, Germany).
3
Noninvasive Ventilation Optimization for Respiratory Decompensation
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NIV was initiated during a scheduled hospitalization, or after a stay in intensive care unit for respiratory decompensation.
Ventilation settings were adjusted according to the machine data, awakening arterial blood gases values, nocturnal oximetry, transcutaneous capnography, ventilatory polygraphy.
The initial objective was to achieve a PaCO₂ < 6 kPa. Inspiratory positive airway pressure was increased in increments of 2 cmH₂O, depending on the patient's tolerance, until achieving PaCO₂ correction. Expiratory positive airway pressure was increased in increments of 1 cmH₂O to correct obstructive events. The safety breathing rate was set by subtracting 2 from the patient's spontaneous breathing rate. When ventilation was not sufficient to correct hypoxemia, oxygen was added to NIV.
The various NIV devices used in this cohort were from Philips Respironics® (mainly Synchrony II, Trilogy 100, BIPAP A30 and A40) and ResMed® (mainly VPAP III ST, Stellar 150 and Lumis 150 ST). Different interfaces were used: nasal, nostril or oronasal mask, depending on patient's tolerance.
Ventilation settings were adjusted according to the machine data, awakening arterial blood gases values, nocturnal oximetry, transcutaneous capnography, ventilatory polygraphy.
The initial objective was to achieve a PaCO₂ < 6 kPa. Inspiratory positive airway pressure was increased in increments of 2 cmH₂O, depending on the patient's tolerance, until achieving PaCO₂ correction. Expiratory positive airway pressure was increased in increments of 1 cmH₂O to correct obstructive events. The safety breathing rate was set by subtracting 2 from the patient's spontaneous breathing rate. When ventilation was not sufficient to correct hypoxemia, oxygen was added to NIV.
The various NIV devices used in this cohort were from Philips Respironics® (mainly Synchrony II, Trilogy 100, BIPAP A30 and A40) and ResMed® (mainly VPAP III ST, Stellar 150 and Lumis 150 ST). Different interfaces were used: nasal, nostril or oronasal mask, depending on patient's tolerance.
4
Initiation of Noninvasive Ventilation with Telemonitoring
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NIV initiation was defined as the first day of the NIV trial. It was performed by a specialised physiotherapist as soon as possible following the NIV prescription on a weekday for at-home initiation or any day of the week for in-hospital initiation.
To benefit telemonitoring, we provided NIV with an integrated telemonitoring device (Lumis 100/150 VPAP ST (ResMed®, Australia), Airview (ResMed®, Australia)) for at-home initiation patients. For the in-hospital initiation patients, a Stellar 150 (ResMed®, Australia) device with an integrated internal battery was used.
A face mask was proposed in the first instance to avoid leaks from mouth control weakness.
The ventilator was set up in the spontaneous timed mode with pressure support (PS) titrated to correct clinically spontaneous respiratory effort. PS was set initially at 4 cmH2O and was gradually adapted according to patient tolerance and comfort to relieve dyspnoea and respiratory effort. In most cases, expiratory positive airway pressure (EPAP) was initially set at 4 cmH2O and could be increased to 8 cmH2O in the event of known obstructive events. Inspiratory triggering, pressurisation and inspiratory to expiratory cycling were adapted to obtain good clinical synchronisation and patient comfort.
To benefit telemonitoring, we provided NIV with an integrated telemonitoring device (Lumis 100/150 VPAP ST (ResMed®, Australia), Airview (ResMed®, Australia)) for at-home initiation patients. For the in-hospital initiation patients, a Stellar 150 (ResMed®, Australia) device with an integrated internal battery was used.
A face mask was proposed in the first instance to avoid leaks from mouth control weakness.
The ventilator was set up in the spontaneous timed mode with pressure support (PS) titrated to correct clinically spontaneous respiratory effort. PS was set initially at 4 cmH2O and was gradually adapted according to patient tolerance and comfort to relieve dyspnoea and respiratory effort. In most cases, expiratory positive airway pressure (EPAP) was initially set at 4 cmH2O and could be increased to 8 cmH2O in the event of known obstructive events. Inspiratory triggering, pressurisation and inspiratory to expiratory cycling were adapted to obtain good clinical synchronisation and patient comfort.
5
Elective Initiation of Noninvasive Ventilation
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The majority of the patients started NIV in an elective setting. Patients had been admitted for diagnostic evaluation and NIV titration normally for 3-5 days. A mandatory back-up rate was always used and titration of inspiratory support and expiratory positive airway pressure were set with the aid of nocturnal monitoring with pulse oximeter, transcutaneous CO 2 and respiratory polygraphy. A further description of the ventilator titration algorithm is available in the Norwegian national guidelines for long term mechanical ventilation [38] . The included patients used the following mechanical ventilators: ResMed devices: VPAP III ST-A (n = 7), S8 VPAP IV ST (n = 20), S9 VPAP ST (n = 15), S9 VPAP ST-A (n = 5), Stellar 150 (n = 8) and Elisée 150 (n = 2). Philips Respironics devices: BIPAP AVAPS (n = 9) and BIPAP SYNCHRONY (n = 1).
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