Mastering PAP device downloads help optimize patient care

Michelle Cao, DO, FCCP
Michelle Cao, DO, FCCP

The Sunday session Mastering PAP and Noninvasive Positive Pressure Ventilation (NIV) Downloads may help you sleep a little better knowing you understand noninvasive ventilation device download reports and can optimize your patients’ care.

“It’s very important to understand PAP (positive airway pressure) devices that are used for sleep apnea and complex sleep-disordered breathing syndromes since the technology for these devices is advancing so quickly,” said Michelle Cao, DO, FCCP, clinical associate professor at Stanford University and chair of the session. “It’s not just about prescribing a PAP device for your patients. You really have to develop a comprehensive understanding of the device’s algorithm and function in order to program the appropriate mode or setting to meet the respiratory needs of your patient.”

The session—which starts at 7:30 am in room 262—is designed to discuss CPAP, bilevel-PAP, and advanced PAP devices, including home ventilators for patients with chronic respiratory insufficiency or failure.

Dr. Cao said there are three main components of a downloaded report: a compliance report for insurance qualifications, sleep apnea controls—the apnea/hypopnea index (AHI)—as well as the mask leak.

“Beyond the three components, the report gives you a lot of information about the patient’s nocturnal and/or daytime respiratory status,” said Dr. Cao, an expert in sleep-disordered breathing and home mechanical ventilation for chronic respiratory failure syndromes. “It also gives us information about the device itself: Is it meeting the patient’s respiratory needs? Do we need to change settings or modalities so that we can better support the patient’s ventilatory impairment? You can really take a deep dive into the report and get a better understanding of the patient’s respiratory status, and that’s where this course is going to help the attendees learn.”

In this case-based session, experts will present specific cases where the medical condition requires a particular device, will review why that device is indicated, why other devices are contraindicated, and then dive into the report and dissect it.

Experts also will address advances in home CO2 monitoring. Traditionally, in order to obtain a patient’s CO2 level, they were sent to the pulmonary function lab for a blood draw or surrogate CO2 monitoring during an in-laboratory sleep study. But now that technology has advanced, surrogate markers for CO2 monitoring, including end tidal C02, can potentially be used in the home setting for diagnostic and treatment purposes. CO2 monitoring is critical in patients who have chronic or advanced respiratory insufficiency/failure.

“We can connect these surrogate CO2 devices to home ventilators and get comprehensive data point of what’s happening during the night with the patient’s ventilatory status,” Dr. Cao said. “This new technology can help better guide management.”

Home CO2 monitoring is not yet standard practice, but Dr. Cao expects it to become routine in the future. For providers who practice sleep medicine and manage patients with sleep-disordered breathing, keeping up with technological advances in PAP devices is absolutely essential, she emphasized.