Results: 5

1.
Figure 3

Figure 3. From: Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS).

Enhanced expiratory rebreathing space montage
The mainstream ETCO2 signal (arrow) provides information about leak (loss of plateau), and maximum/ minimum CO2. Note that during inspiration the ETCO2 usually drops to low/ atmospheric levels as the EERS volume is less than tidal (e.g., 100 mL EERS vs. 500 mL tidal volume), and pressurized fresh incoming air washes out the rebreathing space.

Geoffrey Gilmartin, et al. J Clin Sleep Med. 2010 December 15;6(6):529-538.
2.
Figure 5

Figure 5. From: Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS).

Controlled sleep apnea with rebreathing
The same patient as in , on CPAP with pressure of 12 cm H2O, with 150 mL of enhanced expiratory rebreathing space, with complete resolution of disease. This patient has used rebreathing + CPAP for over 5 years, and has had 3 further positive pressure titration demonstrating the continued requirement for rebreathing for optimal control of mixed obstructive and central sleep apnea.

Geoffrey Gilmartin, et al. J Clin Sleep Med. 2010 December 15;6(6):529-538.
3.
Figure 4

Figure 4. From: Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS).

Uncontrolled sleep apnea without rebreathing
This patient was a 56-year old male. Note persistent central and “mixed” events despite bilevel ventilation, back-up rate, and supplemental oxygen. “Nasal pressure” is mask pressure measures by connecting a pressure transducer to the mask side port. “Nasal flow” is obtained as an output from the positive pressure therapy machine—the unusual appearance of this trace may reflect desynchrony between the patient and the ventilator, as it was not seen when rebreathing space was used.

Geoffrey Gilmartin, et al. J Clin Sleep Med. 2010 December 15;6(6):529-538.
4.
Figure 1

Figure 1. From: Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS).

Enhanced expiratory rebreathing space components
The essential components are available and FDA approved; the assembly and use is off-label. A non-vented mask such as the ResMed Mirage non-vented (top) or a mask that can be made non-vented (such as the Breeze, Activa, Quattro, Liberty, Swift) is required. Other essential components are (from left to right) mainstream CO2 sensing, segments of 22 mm tubing that is the re-breathing space, and the Whisper Swivel valve (Respironics). Use of mainstream CO2 sensing has the additional advantage of providing functional leak information.

Geoffrey Gilmartin, et al. J Clin Sleep Med. 2010 December 15;6(6):529-538.
5.
Figure 2

Figure 2. From: Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS).

Enhanced expiratory rebreathing space assembled
The fully assembled EERS system consists of, in series, a non-vented interface, CO2 sensing (during laboratory use only), the rebreathing space, exhalation valve, and then the conventional positive pressure circuit. To add additional rebreathing space, our technicians are able to manually add 6-inch segments (approximately 50 mL) in less than 3 seconds, without disturbing sleep. Such changes occur infrequently during a titration study, as the typical range tested is 100-150 mL (2-3 segments). One method of choosing the initial rebreathing volume is described in .

Geoffrey Gilmartin, et al. J Clin Sleep Med. 2010 December 15;6(6):529-538.

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