This past year our facility has purchased a few Respironics Vision BiPAP devices. There has been a fairly steap learning curve as to how some of the adjuncts work especially with regards to P.A.V. We have had a few guest lectures and numerous papers to review however there still remains a disconcensus as to the value of this mode.

My experience with PAV thus far has been mixed> I have experienced a few cases where there was noticable and inexplicable dyssynchrony for lack of a better description. This was remediated by switching back to ST. PTs in other facilities are reportably more comfortable on PAV than on ST mode. I have noticed that with Vast and Flow Ast I am able to achieve a level of comfort however in all honesty I dont know whether it is any more effective than ST mode.

The theory of PAV is apparrent to me however clinically it seems to be lots of knob twisting for an affect which can easily be duplicated in ST mode. Do you find the same to be true? Can you offer suggestions on how to use this mode more effectively?

Finally if you set an IPAP level on the Vision for PAV anyway what is the purpose of having a Flow and Volume assist if youve already establihed the ventilating pressure. Just how does PAV actually deliver the flow in such a way that is more comfortable or some how different than in ST mode?

This was a long question sorry, Im just trying to advocate to my collegues the benefit of using PAV but Im struggling to answer some of these questions.

Thankyou for your time

Andrew
anfin@hotmail.com