AVAPS-IVAPS EXPLANATION AND GUIDLINES

Non-Invasive Ventilation Explanation

What is the difference between a Trilogy (AVAPS) &/or Astral (IVAPS) Machine and a BiPAP &/or CPAP Machine?

CPAP & BiPAP Therapy:

A CPAP (continuous positive air pressure) machine and a BiPAP (bi-level positive air pressure) are machines that are generally used to help prevent obstructive sleep apnea (OSA) or central sleep apnea (CSA). These machines need a mask interface that the patient places over their nose (nasal mask) or over their nose and mouth (full face mask). Sometimes oxygen is also bled into the machine to assist with oxygenation.

Which patients?

  • Fluid overload patients: chronic heart failure (CHF) or even pneumonia (not approved for home unit with this diagnosis)
  • Chronic obstructive pulmonary disease (COPD) to help reduce the high CO2 level that these patients may have (pCO2 > 52 mm hg on prescribed FIO2 for home unit approval)
  • OSA patients (sleep study is required for home unit approval)
  • CSA patients (sleep study is required for home unit approval)

The Difference:

While CPAP or BiPAP therapy provides a prescribed pressure to alleviate obstruction the AVAPS or IVAPS mode provides a target tidal volume to assist with ventilation. The two main types of machines used to provide this mode of ventilation are the Astral (Resmed) and the Trilogy (Respironics).

*A CPAP or BiPAP machine used on an artificial airway (Tracheostomy) is considered a form of ventilation in the United States. These types of patients need to be at a skilled nursing facility (SNF) that have ventilator privileges by state regulatory associations

AVAPS Mode or IVAPS Mode:

AVAPs (average volume assured pressure support) and IVAPs (intelligent volume assured pressure support) are support functions that automatically adapts pressure support to patient needs to guarantee and average tidal volume.

Which patients?

  • morbid obese hypoventilation patients
  • COPD patients with chronic respiratory failure
  • severe neuromuscular or restrictive thoracic disease.

These machines need a mask interface that the patient places over their nose (nasal mask) or over their nose and mouth (full face mask). Sometimes oxygen is also bled into the machine to assist with oxygenation.

*An Astral machine or a Trilogy machine used on an artificial airway (Tracheostomy) is considered a form of ventilation in the United States. These types of patients should be admitted to a skilled nursing facility (SNF) that have ventilator privileges by state regulatory associations.

Non-Invasive Ventilation Settings:

IVAPS (ResMed)

Patient Height: (**MUST have patient height)

Tidal Volume rate:
PS Min: cmH2O(cwp) Inspiratory Time Min: sec

EPAP/PEEP: cmH2O(cwp) AVAPS (Respironics)

Target Tidal Volume: IPAP Min: cmH2O(cwp) EPAP: cmH2O(cwp) PS Max: cmH2O(cwp) Inspiratory Time Max: sec
OR

Rate: Inspiratory Time: sec IPAP Max: cmH2O(cwp) Pressure Support:

How is this covered for Home Health?

A DME provider can assist with placement of a Trilogy or Astral patient and certain co- morbidities are covered for non-invasive ventilation:

  • Severe neuromuscular or restrictive thoracic diseases
  • Chronic respiratory failure (CRF) consequent to severe chronic obstructive pulmonary disease (COPD)

Documentation that supports non-invasive ventilation in the Home Setting:

  • Patients medical history & respiratory ailment
  • For patients with CRF consequent to COPD, one of the following:
    • pCO2 > 52 mm Hg or FEV1 < 50% of predicted or
    • pCO2 between 48-51 mm Hg of FEV1 < 51-60% of predicted obtained and have 2 or more respiratory-related hospital admissions within the past 12 months
  • The medical necessity for pressure support ventilation including, but not limited to, progress of the patient’s disease state, prior treatment results and current treatment plans
  • If patient was previously on bi-level with or without rate as an outpatient, documentation of why bi-level therapy is not sufficient for the patient
  • For neuromuscular patients, FVC or MIP/NIF tests results
  • For restrictive thoracic patients, pCO2 or FVC test results
  • Recent hospital admission/readmission