1. AVAPS TM Feature More about the Algorithm Efficiency Comfort Safety Versatility Prediction How to improve Efficiency of ventilation and Comfort of patient?

2. AVAPS Algorithm 1.Estimation of Vte at each breath (Auto-TRAK) 2.Comparison of the averaged Vte with target Vte 3.Calculation of the pressure to add to reach the target Vte 4.Progressive increase of the IPAP (< 1cmH 2 O/min) from breath to breath  If the patient is unstable: the IPAP cannot change by more than 0.5 cmH 2 O/min  If the cycle is not « regular » (sudden leak increase or decrease, patient sigh, the patient talks..etc), it is not taken into account: constant IPAP  Starting pressure support (starting point) = Target Vt / (60 ml/cmH 2 O)

3. Time Exhaled patient tidal volume is estimated at each breath Vte Estimation Vti Vte Vti > Vte Vti – Vte = ∆ Leaks > 0 Inspiratory Phase Expiratory Phase Flow Zero Patient Vti Vte Vti Vte Vti < Vte Vti – Vte = ∆ Leaks < 0 1 Vti = Vte Vti – Vte = ∆ Leaks = 0 2 3

4. Pressure Support Calculation Missing Vte Target Vte – Estimated Vte Elastance Vte of that breath PS of that breath PS to add = Average missing Vte x Average Elastance New PS = PS of that breath + PS to add For Each Breath

5. Breath to Breath, Pressure Support Changes IPAP Max IPAP Min EPAP Vte = Vt patient < 1 cmH 2 O/min Target Vt

6. Example  Target Vte = 250 ml Pressure Patient flow  Next breath: ‐ Pressure to add = (0,8 x Tbreath) / 60 If Tbreath = 4s then pressure to add is 0,05 cmH 2 O for a stable respiration and 0,03 cmH 2 O for an unstable respiration  Measurements: ‐ Measured average PS = 6 cmH 2 O ‐ Estimated average Vte = 220 ml  Calculation: ‐ Missing average Vte = 30 ml ‐ Pressure to add = (6 / 220) x 30 = 0,8 cmH 2 O (progressively within the next minute) ‐ New pressure support = 6,8 cmH 2 O

7. Starting Pressure Support  Target Vte = 600 ml  EPAP = 5 cmH 2 O  IPAP Min = 12 cmH 2 O  IPAP Max = 20 cmH 2 O  Starting point : ‐ Starting Pressure Support = 600ml x ( 1 cmH 2 O/60ml) = 10 cmH 2 O ‐ Starting IPAP = 15 cmH 2 O The Synchrony starts the ventilation with a pressure support of 1cmH 2 0 / 60ml of the set target Vte Example :

8. Conclusion  Reliable algorithm based on RI Technology (Auto-TRAK: leaks and Vte estimation): ‐ Efficient pressure changes based on Vte ‐ Stable algorithm not affected by leaks  Small and progressive pressure changes that do not deteriorate patient comfort  This algorithm allows you to combine comfort of patient with safety and efficiency of ventilation