ResMed VPAP ST-A User manual

Making quality of care easy
Respiratory Care Solutions
VPAP™ST-A with iVAPS
NONINVASIVE VENTILATOR
H5i™
HEATED HUMIDIFIER
Clinical Guide
English

Making quality of care easy
Respiratory Care Solutions

i
English
Contents
Welcome ..................................................................................................... 1
VPAP ST-A indications for use .............................................................. 1
VPAP ST-A contraindications................................................................. 1
VPAP ST-A adverse effects ................................................................... 1
H5i indications for use.......................................................................... 1
H5i contraindications............................................................................ 1
VPAP ST-A at a glance .................................................................................. 2
Travelling with the VPAP ST-A ............................................................... 2
H5i at a glance ............................................................................................. 3
Travelling with the H5i .......................................................................... 3
Operating information .................................................................................. 4
Bilevel pressures .................................................................................. 4
Modes of operation.............................................................................. 4
More about iVAPS ................................................................................ 6
Target alveolar ventilation........................................................... 7
Target Patient Rate..................................................................... 8
Min/Max PS ............................................................................... 9
Ramp.................................................................................................... 9
Alarms ................................................................................................ 10
Noninvasive ventilation and leak management .................................. 10
Triggering and cycling......................................................................... 10
Rise time adjustment ......................................................................... 10
TiControl™– Inspiratory Time Control ................................................. 11
Climate Control .................................................................................. 12
S9 Essentials...................................................................................... 13
Sleep Quality ...................................................................................... 13
Setting up................................................................................................... 14
Mask and air tubing settings .............................................................. 15
Filling the water tub ................................................................................... 16
VPAP ST-A basics ....................................................................................... 17
Navigating the menus ................................................................................ 18
About the menus ....................................................................................... 18
Home menu ....................................................................................... 18
Changing settings via the Home menu.................................... 19
S9 Essentials............................................................................ 19
Viewing the treatment screens................................................ 20
Treatment screen parameters.................................................. 21
Setup menu........................................................................................ 22
Patient Setup menu ................................................................. 22
Clinical Setup menu ................................................................. 22
Clinical setup menu parameters
................................................................................................................ 23
Configuring iVAPS .................................................................... 27
Info menu........................................................................................... 28
Standard Info menu ................................................................. 28

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Advanced Info menu ................................................................ 28
Clinical Info menu..................................................................... 29
Info menu parameters.............................................................. 29
Managing Climate Control ......................................................................... 31
Working with alarms .................................................................................. 32
Alarms menu...................................................................................... 33
Adjustable alarm settings ................................................................... 33
Testing the alarms .............................................................................. 34
Initial setup............................................................................... 34
Common alarms and solutions........................................................... 35
Delivering therapy ...................................................................................... 37
Adding supplemental oxygen ............................................................. 37
Managing data ........................................................................................... 38
SD card............................................................................................... 38
Removing the card ............................................................................. 38
Inserting the card ............................................................................... 38
Analysing the SD card data ................................................................ 39
Data storage....................................................................................... 39
Data transmission adapter ................................................................. 39
Cleaning and maintenance......................................................................... 40
Disassembling the H5i ....................................................................... 40
Daily ................................................................................................... 40
Monthly .............................................................................................. 41
Reassembling the H5i ........................................................................ 41
Maintenance checklist........................................................................ 41
Reprocessing the H5i between patients............................................ 41
Replacing the air filter......................................................................... 42
Antibacterial filters ............................................................................. 42
Technical specifications.............................................................................. 43
General technical specifications ......................................................... 43
VPAP ST-A technical specifications..................................................... 44
H5i technical specifications ................................................................ 44
Air tubing technical specifications ...................................................... 45
Humidifier performance ..................................................................... 45
Pneumatic flow path .......................................................................... 45
Flow (maximum) at set pressures...................................................... 46
Displayed values................................................................................. 46
Warnings and cautions............................................................................... 48
WARNINGS ........................................................................................ 48
CAUTIONS.......................................................................................... 48

1
English
Welcome
Thank you for choosing the VPAP ST-A with iVAPS (hereafter ’VPAP ST-A’) or H5i.
Before operating these devices, please read the entire Clinical and Information Guides.
VPAP ST-A indications for use
The VPAP ST-A is indicated to provide noninvasive ventilation for patients weighing more than 13 kg or
more than 30 kg in iVAPS mode with respiratory insufficiency or obstructive sleep apnoea (OSA). The
VPAP ST-A is intended for home and hospital use.
VPAP ST-A contraindications
Positive airway pressure therapy may be contraindicated in some patients with the following pre-existing
conditions:
•severe bullous lung disease
•pneumothorax or pneumomediastinum
•pathologically low blood pressure, particularly if associated with intravascular volume depletion
•dehydration
•cerebrospinal fluid leak, recent cranial surgery, or trauma.
VPAP ST-A adverse effects
Patients should report unusual chest pain, severe headache, or increased breathlessness to their
prescribing physician. An acute upper respiratory tract infection may require temporary discontinuation of
treatment.
The following side effects may arise during the course of therapy with these devices:
•drying of the nose, mouth, or throat
•nosebleed
•bloating
•ear or sinus discomfort
•eye irritation
•skin rashes.
H5i indications for use
The H5i is indicated for the humidification of the air delivered from a CPAP or bilevel device. The H5i is
for use only as recommended by a physician. The H5i is intended for single patient re-use in the home
environment and re-use in a hospital/institutional environment.
H5i contraindications
The H5i is contraindicated for use with patients whose upper (supraglottic) airway has been bypassed.

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Air filter
DC power inlet
SD card slot
Module/Adapter port
Air outlet
VPAP ST-A at a glance
The VPAP ST-A system comprises the following elements:
•VPAP ST-A device
•Air tubing
•90W power supply unit
•S9 travel bag
•SD card
•S9 SD card protective folder.
Optional components include:
•H5i heated humidifier
•Standard air tubing
•SlimLine™air tubing
•3 m air tubing
•ClimateLine™heated air tubing
•ClimateLineMAX ™heated air tubing
•30W power supply unit (does not support H5i)
•Power Station II battery pack
•DC/DC Converter 24V/90W
•S9 Oximeter Adapter.
Travelling with the VPAP ST-A
When the patient travels with the VPAP ST-A only:
•Advise the patient to pack the SlimLine or Standard air tubing as the ClimateLine or ClimateLineMAX
heated air tubing is not designed to connect directly to the device.
•Advise the patient to purchase and travel with the approved power cord for the region where they will
be using the device.
•ResMed confirms that the VPAP ST-A meets the Federal Aviation Administration (FAA) requirements
(RTCA/DO-160, section 21, category M) for all phases of air travel.

3
English
Latch
Release
button
ClimateLine or
ClimateLineMAX
connection port
Air outlet
Flip lid
Flip lid seal
H5i water tub
H5i at a glance
The H5i system comprises the following elements:
•H5i heated humidifier
•H5i cleanable water tub
•ClimateLine heated air tubing (if sold as a Climate Control Kit).
Optional components include:
•H5i standard water tub
•ClimateLineMAX heated air tubing
Travelling with the H5i
When moving or travelling with the H5i:
•Ensure that the water tub is empty.
•Disconnect the H5i from the VPAP ST-A by pressing the release button.

4
Operating information
The device uses internal pressure and flow sensors in the air path to respond reliably to patient flow rates
even in the presence of most normal leaks in the patient circuit.
Bilevel pressures
The device assists spontaneous breathing by cycling between two pressures in response to the patient
flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure support level) assists
inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through the mask exhaust
vent. This facilitates exhalation comfort while providing a splint to maintain an open upper airway.
The difference of the two pressures—pressure support (PS) level—contributes to improved patient
ventilation.
Modes of operation
The following table describes the operating modes available on the VPAP ST-A.
Modes
CPAP
A fixed pressure is delivered.
S (Spontaneous)
You may set two treatment pressures-–one for inspiration (IPAP) and one for expiration (EPAP). The
device senses when the patient is inhaling and exhaling and supplies the appropriate pressures
accordingly. The difference between IPAP and EPAP levels helps determine the tidal volume.
ST (Spontaneous/Timed)
The device augments any breath initiated by the patient, but will also supply additional breaths should
the patient breath rate fall below the clinician’s set “backup” breath rate.
T (Timed)
The fixed breath rate and the fixed inspiration/expiration time set by the clinician is supplied regardless
of patient effort.
PAC (Pressure Assist Control)
The inspiration time is preset in the PAC mode. There is no spontaneous/flow cycling. The inspiration
can be triggered by the patient when respiratory rate is above a preset value, or time triggered breath
will be delivered at the backup breath rate.
iVAPS (intelligent Volume Assured Pressure Support)
iVAPS is designed to maintain a preset target alveolar minute ventilation by monitoring delivered
ventilation, adjusting the pressure support and providing an intelligent backup breath automatically. The
iVAPS therapy mode is indicated for patients weighing 66 lbs (30 kg) and above.
Pressure
Support
Pressure
IPAP
0
EPAP
One breath cycle
Time
Rise time

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English
The following diagram illustrates these operating modes (excluding CPAP mode where a single level of
continuous pressure is delivered).
IPAP
No breath effort
Long breath
(Leak or obstructive lungs)
Very short breath
(Restrictive lungs)
Inspiration
Patient
Effort
Leak flow
S
S/T
T
Expiration
EPAP
IPAP
EPAP
IPAP
EPAP
iVAPS
EPAP
PAC
IPAP
EPAP
PS
Machine initiates inspiratory phase increasing pressure up from EPAP
Ti Max: inspiratory phase cycled down to EPAP at Ti Max
Ti
One breath cycle
Period of increased leak
Ti Min: inspiratory phase sustained up to Ti Min
Ti Min
Ti Max
Ti: machine initiates expiratory phase decreasing pressure down to EPAP

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The common adjustable settings for different modes in the VPAP ST-A are shown below.
Settings S ST TPAC iVAPS CPAP
Set pressure ü
IPAP üüüü
EPAP üüüüü
Respiratory rate üüü
Ti ü ü
Target Va ü
Target Patient Rate ü
Ti Max ü ü ü
Ti Min ü ü ü
Rise time üüüüü
Trigger sensitivity ü ü ü ü
Cycle sensitivity ü ü ü
Min PS ü
Max PS ü
Height ü
More about iVAPS
You may prefer some assurance that the patient’s ventilatory needs will be defended if their condition
varies. A variety of ‘dual mode’ schemes exist, that aim to combine the benefits of pressure target and
volume target, most of which can be categorised generically as volume-assured pressure support, or
VAPS modes.
With VAPS devices in general, the ventilatory assistance (pressure support) aims to automatically adjust
to changes in patient condition over time, typically to maintain a target tidal volume.
iVAPS offers the comfort and synchrony of pressure support, but with the assurance offered by a volume
target. iVAPS has the following advantages over traditional VAPS schemes:
•iVAPS is a unique combination for a servo-controlled ventilator, in that iVAPS has the goal of
regulating alveolar ventilation to a prescribed target, and iVAPS has a swift but gentle servocontrol
response. iVAPS is tuned to be fast enough to avoid blood-gas derangement associated with most
breathing challenges, including during sleep, but is gentle enough to avoid disruption.
•iVAPS has an intelligent Backup Rate (iBR) which aims to keep ‘out of the way’ while the patient is
breathing, yet during sustained apnoea will mimic the patient’s own breath rate. This contributes to
iVAPS’ ability to maintain its ventilation target and so stabilise blood gases even during sleep.
•iVAPS has ResMed’s robust leak compensation scheme (Vsync). This promotes synchrony and
comfort even during significant leak.
Max PS
Min PS
Pressure
Time
Pressure
Target alveolar ventilation
Current alveolar ventilation

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English
Target alveolar ventilation
iVAPS targets alveolar ventilation. Alveolar ventilation was chosen because it is at the level of the alveoli
that gas exchange occurs. Total ventilation includes the ventilation devoted to the conducting airways,
whereas alveolar ventilation best represents the useful portion of ventilation that reaches the alveoli.
Alveolar ventilation cannot be measured directly, so iVAPS estimates it using a height approximated value
of anatomical deadspace as shown in the graph below. Anatomic deadspace is the amount of breath
that remains in the conducting airways, which does not reach alveoli and does not contribute to gas
exchange. Its contribution is proportional to breath rate. By using alveolar ventilation as a servoventilation
target, as opposed to tidal volume or minute ventilation, the effect of respiratory rate change on effective
ventilation is negated.
Anatomical Deadspace Estimation
iVAPS Deadspace
Estimation
Height (in)
Anatomical Deadspace Estimate (ml)
35 35 40 45 50 55 60 65 70 75 80
25
50
75
100
125
150
175
200
225
Adapted from Hart MC et al. Journal Applied Physiology.18(3), p519-522. 1963

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Target Patient Rate
iVAPS has a novel approach to providing a backup rate. Instead of mandating a fixed backup rate, iVAPS’
intelligent Backup Rate (iBR) will shift automatically between two limits, according to the context. The
benefit of this approach is improved synchrony, while maximising iVAPS’ ability to maintain the target
ventilation, at minimal pressure support.
•During sustained apnoea, the iBR will adopt a pre-configured Target Patient Rate. This Target Patient
Rate defines the upper boundary for iBR. You set the Target Patient Rate to match the patient’s
average spontaneous rate (unlike a traditional backup rate).
•During spontaneous ventilation, the iBR adjusts to remain well in the background, at two-thirds of
the Target Patient Rate. This ‘background’ backup rate is lower than a traditional S/T rate, so gives the
patient maximum opportunity to spontaneously trigger.
•When spontaneous triggering ceases (eg, at the onset of an apnoea/hypopnoea), the iBR adjusts
from its background frequency to its Target Patient Rate. It will adjust quickest (within 4–5 breaths)
when ventilation is below the target ventilation.
•A single spontaneous triggered breath resets the iBR to its background rate (two-thirds of Target
Patient Rate).
Time
Breaths per minute
Target patient rate
15
10
iVAPS intelligent back-up rate (iBR)Patient spontaneous rate
Patient effort No Patient effort Patient effort
iBR brings the patient back on target when back-up breaths are required

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English
Min/Max PS
The default settings for maximum and minimum pressure support are normally adequate, but you may
wish to alter them in some patients.
Min PS and Max PS define the range of pressure support adjustment available to the iVAPS algorithm as
it regulates alveolar ventilation.
It is recommended that Max PS be set high enough to allow the alveolar ventilation target to be met,
while exercising clinical judgement over considerations such as patient comfort and tolerance, lung
mechanics, age, mask seal, etc.
It is recommended that Min PS is left at the level set when learning the patient’s ventilation target
(default 4 cm H2O) unless the patient finds this too little for comfort.
Ramp
Ramp is designed to make the beginning of treatment more comfortable.
In CPAP mode during ramp time, the pressure increases from a low pressure to the prescribed treatment
pressure.
In S, ST and T modes, ramp time defines the period during which the EPAP gradually increases from the
StartEPAP to the prescribed treatment pressure. Pressure support remains at set PS during ramp.
In iVAPS mode, ramp time defines the period during which the EPAP gradually increases from the
StartEPAP to the Min EPAP. Pressure support remains at Min PS during ramp.
Min PS
0
Ramp time
Start EPAP
Time
Min PS
Max PS
EPAP
IPAP
EPAP
0
Ramp time
Time
Start EPAP

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Alarms
The VPAP ST-A is fitted with an alarm module that continuosly monitors both therapy and device
conditions.
When an alarm condition occurs:
•an alarm message appears on the LCD screen
•the yellow alarm LED indicator flashes
•an audible alarm sounds.
For further information, see Working with alarms.
Noninvasive ventilation and leak management
Two critical factors for the success of non-invasive ventilation therapy are:
•ventilator triggering—sensing inspiratory effort and determining the end of inspiration
•time taken to reach and maintain the set pressure, espcially in the presence of leak.
The device has a unique leak management algorithm, Vsync, that monitors and compensates for leak by
continuously and automatically adjusting the baseline flow. This enables reliable triggering and cycling
while maintaining the set pressures.
Triggering and cycling
Under normal conditions, the device triggers (initiates IPAP) and cycles (terminates IPAP and changes to
EPAP) as it senses the change in patient flow.
In addition, the device has adjustable trigger/cycle sensitivity to optimise the sensing level according to
patient conditions.
Rise time adjustment
Rise Time sets the time taken for the device to reach the set inspiratory pressure after triggering. The
greater the Rise Time value, the longer it takes for pressure to increase from EPAP to IPAP.
Patients with a high ventilatory demand may prefer a shorter Rise Time, while patients who are slow
breathers may prefer a longer Rise Time.
Very low
Medium
Very high
Patient flow
Very low
Medium
Very high
Patient flow
Adjustable trigger sensitivity Adjustable cycle sensitivity

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TiControl™– InspiratoryTime Control
Unique to ResMed bilevel devices, TiControl allows the clinician to set minimum and maximum limits
on the time the device spends in IPAP. The minimum and maximum time limits are set at either side of
the patient’s ideal spontaneous inspiratory time, providing a ’window of opportunity’ for the patient to
spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit is set via the Ti Max
parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximising synchronisation
by effectively intervening to limit or prolong the inspiratory time when required. This ensures
synchronisation even in the presence of significant mouth and/or mask leak.
The following table is a guide to selecting the Ti Max and Ti Min values that best correspond to the
patient’s respiratory rate and inspiration and expiration ratio, depending on the respiratory conditions.
Notes:
•I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose inspiratory effort is
extremely weak.
•I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer expiration time.
Patient breath
(BPM)
Ttot = 60/BPM
(sec)
I:E = 1:2
(Reference)
Sufficient inhalation time
I:E = 1:1
Secure
exhalation
time
I:E = 1:3
Ti Min Ti Max Ti Max
10 6 2 1. 0 2.0 1. 5
15 41. 3 1. 0 2.0 1. 3
20 3 1. 0 0.8 1. 5 1. 0
25 2.4 0.8 0.7 1. 2 0.8
30 2 0.7 0.6 1. 0 0.7
35 1. 7 0.6 0.5 0.8 0.7
40 1. 5 0.5 0.5 0.7 0.7
Patient flow
Pressure
Ti Max
Ti Min Cycle
Window

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Climate Control
The VPAP ST-A when used in conjunction with the H5i and ClimateLine or ClimateLineMAX heated air
tubing, offers a feature called Climate Control.
Climate Control enables the automatic delivery of a constant value of absolute humidity to the patient’s
upper airway while protecting against rainout and allowing patients to select the air temperature that
offers the most comfort for them.
Rainout protection
Rainout refers to the water or condensation that collects in the patient’s tubing or mask. Rainout is a
common side effect of using a humidifier due to the humidified air cooling as it travels down the tubing
and into the mask. Rainout occurs when relative humidity, which is a measure of the air’s capacity to hold
water vapour, exceeds 100%.
Climate Control protects the patient from rainout by maintaining a target relative humidity of 80% as well
as maintaining the temperature of the air delivered to the patient without compromising the amount of
absolute humidity delivered.
Automatic constant humidity delivery
For each temperature setting, the Climate Control system delivers a constant amount of water vapour, or
absolute humidity, to the patient’s upper airway. The following table shows the target absolute humidity
value that will be delivered to the mask for a selection of temperature settings.
Temperature delivered to the mask Target absolute humidity at the mask,
Body Temperature Pressure Saturated (BTPS)
16ºC 10 mg/L
20ºC 12 mg/L
24ºC 16 mg/L
27ºC 19 mg/L
30ºC 22 mg/L
Automatic constant temperature delivery
The temperature sensor located at the mask end of the ClimateLine or ClimateLineMAX heated air
tube enables the system to automatically control the temperature of the air delivered to the patient.
This ensures the temperature of the air delivered to the patient does not fall below the set minimum
temperature, therefore maximising breathing comfort for the patient.
Automatic adjustment
The H5i and ClimateLine or ClimateLineMAX heated tubing are controlled by the Climate Control algorithm
to deliver constant humidity and temperature outputs. The system adjusts automatically to changes in:
•ambient room temperature and humidity values
•flow due to pressure changes
•flow due to mask or mouth leak.

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S9 Essentials
S9 Essentials is designed to make device interaction and menu navigation easier for patients. If enabled,
S9 Essentials disables the Info and Setup functionality so that patients can simply start and stop therapy
and adjust ramp, humidification and Climate Control. S9 Essentials can be enabled via Clinical Setup >
Options > Access.
Sleep Quality
Designed to promote compliance, the Sleep Quality indicator allows the patient to actively engage in
their own therapy by identifying leak, usage and AHI information. This information can be set to:
•Usage—where only usage hours are displayed
•On—where usage, mask fit and AHI information are displayed.

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Setting up
1. Align the H5i with the VPAP ST-A and push them together until they click into place.
2. Connect the DC plug of the power supply unit to the rear of the device.
3. Connect the power cord to the power supply unit.
4. Plug the other end of the power cord into the power outlet.
5. Connect one end of the air tubing firmly onto the air outlet.
6. Connect the assembled mask system to the free end of air tubing.
Notes:
•Always ensure that the VPAP ST-A and H5i are placed on a stable, level surface for proper operation.
•Always ensure that the VPAP ST-A is placed in an area where the alarm LED indicators are clearly
visible.
•Place the power supply unit away from the H5i to allow for adequate ventilation.

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Mask and air tubing settings
Use the following settings below for each mask type:
Mask type Settings
Full Face Full Face
Pillows Pillows
Nasal Nasal (for Ultra Mirage mask, use ‘Nasal Ultra’)
Pediatric Pediatric
Notes:
•For more information on assembling the mask see the mask user guide.
•For a complete list of recommended masks and their settings go to www.resmed.com on the
Products page under Service & Support. If you do not have internet access, please contact your
ResMed representative.
The VPAP ST-A is compatible with the following air tubing:
Air tubing Specifications Settings
ClimateLine Heated
Length: 2 m
Inner diameter: 15 mm
Automatically detected
ClimateLineMAX Heated
Length: 1.9 m
Inner diameter: 19 mm
Automatically detected
SlimLine: Length: 1.8 m
Inner diameter: 15 mm
If using the SlimLine, Standard or 3 m
air tubing, adjust the tube setting in the
Patient Setup or Clinical Setup menus.
Standard Length: 2 m
Inner diameter: 19 mm
3 m Length: 3 m
Inner diameter: 19 mm
Notes:
•When using the SlimLine or ClimateLine above 20 cm H2O, the device optimum performance may
not be reached if used with an antibacterial filter. The device performance must be checked prior to
prescribing the SlimLine for use with an antibacterial filter.
•The ClimateLine/ClimateLineMAX are designed only for use with the H5i.

16
Filling the water tub
1. Slide the latch and lift open the flip lid.
2. Remove the water tub.
3. Fill the water tub (through the centre hole) with water up to the maximum water level mark (380 mL).
4. Return the water tub to the H5i.
5. Close the flip lid ensuring that it clicks into place.