mechanical Archives - Critical Care Science (CCS)
, , , , Abstract
Rev Bras Ter Intensiva. 2022;34(3):351-359
DOI 10.5935/0103-507X.20220383-en
, , , , , , , , , , , , , , , , , , , , , , , To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost.
The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided.
The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period.
This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.
Abstract
Rev Bras Ter Intensiva. 2022;34(3):351-359
DOI 10.5935/0103-507X.20220383-en
, , , , , , , , , , , , , , , , , , , , , , , To develop a simple, robust, safe and efficient invasive mechanical ventilator that can be used in remote areas of the world or war zones where the practical utility of more sophisticated equipment is limited by considerations of maintainability, availability of parts, transportation and/or cost.
The device implements the pressure-controlled continuous mandatory ventilation mode, complemented by a simple assist-control mode. Continuous positive airway pressure is also possible. The consumption of compressed gases is minimized by avoiding a continuous flow of oxygen or air. Respiratory rates and inspiration/expiration time ratios are electronically determined, and an apnea/power loss alarm is provided.
The pressure profiles were measured for a range of conditions and found to be adjustable within a ± 2.5cmH2O error margin and stable well within this range over a 41-hour period. Respiratory cycle timing parameters were precise within a few percentage points over the same period. The device was tested for durability for an equivalent period of four months. Chemical and biological tests failed to identify any contamination of the gas by volatile organic compounds or microorganisms. A ventilation test on a large animal, in comparison with a well established ventilator, showed that the animal could be adequately ventilated over a period of 60 minutes, without any noticeable negative aftereffects during the subsequent 24-hour period.
This ventilator design may be viable, after further animal tests and formal approval by the competent authorities, for clinical application in the abovementioned atypical circumstances.
Abstract
Rev Bras Ter Intensiva. 2021;33(4):616-623
DOI 10.5935/0103-507X.20210071
Manual hyperinflation is used in neonatal and pediatric intensive care units to promote expiratory flow bias, but there is no consensus on the benefits of the technique. Thus, a review that presents supporting evidence is necessary. This study aims to review the literature on the manual hyperinflation maneuver in neonatal and pediatric intensive care units to analyze the evidence for this technique in terms of the forms of application (associated with other techniques or not), its safety, the performance of manual resuscitators and the influence of the physical therapist’s experience, in addition to evaluating the methodological quality of the identified articles. A search was performed in the following databases: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL and SciELO. Two researchers independently selected the articles. Duplicate studies were assessed, evaluated by title and abstract and then read in full. The quality of the articles was analyzed using the PEDro scale. Six articles were included, two of which had high methodological quality. The main results provided information on the contribution of the positive end-expiratory pressure valve to increasing lung volumes and the use of chest compressions to optimize expiratory flow bias, the negative influence of operator experience on the increase in peak inspiratory flow, the performance of different manual resuscitators when used with the technique and the safety of application in terms of maintaining hemodynamic stability and increasing peripheral oxygen saturation. The available studies point to a positive effect of the manual hyperinflation maneuver in children who are admitted to intensive care units.
Registration PROSPERO: CRD42018108056.
Abstract
Rev Bras Ter Intensiva. 2021;33(4):616-623
DOI 10.5935/0103-507X.20210071
Manual hyperinflation is used in neonatal and pediatric intensive care units to promote expiratory flow bias, but there is no consensus on the benefits of the technique. Thus, a review that presents supporting evidence is necessary. This study aims to review the literature on the manual hyperinflation maneuver in neonatal and pediatric intensive care units to analyze the evidence for this technique in terms of the forms of application (associated with other techniques or not), its safety, the performance of manual resuscitators and the influence of the physical therapist’s experience, in addition to evaluating the methodological quality of the identified articles. A search was performed in the following databases: Web of Science, ScienceDirect, PubMedⓇ, Scopus, CINAHL and SciELO. Two researchers independently selected the articles. Duplicate studies were assessed, evaluated by title and abstract and then read in full. The quality of the articles was analyzed using the PEDro scale. Six articles were included, two of which had high methodological quality. The main results provided information on the contribution of the positive end-expiratory pressure valve to increasing lung volumes and the use of chest compressions to optimize expiratory flow bias, the negative influence of operator experience on the increase in peak inspiratory flow, the performance of different manual resuscitators when used with the technique and the safety of application in terms of maintaining hemodynamic stability and increasing peripheral oxygen saturation. The available studies point to a positive effect of the manual hyperinflation maneuver in children who are admitted to intensive care units.
Registration PROSPERO: CRD42018108056.
Abstract
Rev Bras Ter Intensiva. 2006;18(1):34-37
DOI 10.1590/S0103-507X2006000100007
BACKGROUD AND OBJECTIVES: The high frequency oral oscillation therapy (HFOO) is carried through a plastic device which promotes the clearance of pulmonary sputum. This possesses a metallic sphere which, oscillates during the expiration, generating oscillatory positive expiratory pressure. The aim of this study was to verify the performance of the national device of HFOO (Shaker, NCS, São Paulo) in relation to frequency of oscillation and expiratory pressure with variation of flow and inclination. METHODS: The device was imprisoned to a circuit that consisted of a pneumotacograph and a mechanical ventilator. This had the varied flow and during this variation the expiratory pressure and the frequency of oscillation of the device were measured in angulations which, varied of +40º to -40º. RESULTS: Significant correlation between flow and expiratory pressure in each level of inclination was found. A bigger frequency of oscillation and pressure was evidenced in the positive angulations with the biggest flows (50 and 60 L/min). CONCLUSIONS: The high frequency oral oscillation device can be used as an assist for the air way clearance therapy during mechanical ventilation.
Abstract
Rev Bras Ter Intensiva. 2006;18(1):34-37
DOI 10.1590/S0103-507X2006000100007
BACKGROUD AND OBJECTIVES: The high frequency oral oscillation therapy (HFOO) is carried through a plastic device which promotes the clearance of pulmonary sputum. This possesses a metallic sphere which, oscillates during the expiration, generating oscillatory positive expiratory pressure. The aim of this study was to verify the performance of the national device of HFOO (Shaker, NCS, São Paulo) in relation to frequency of oscillation and expiratory pressure with variation of flow and inclination. METHODS: The device was imprisoned to a circuit that consisted of a pneumotacograph and a mechanical ventilator. This had the varied flow and during this variation the expiratory pressure and the frequency of oscillation of the device were measured in angulations which, varied of +40º to -40º. RESULTS: Significant correlation between flow and expiratory pressure in each level of inclination was found. A bigger frequency of oscillation and pressure was evidenced in the positive angulations with the biggest flows (50 and 60 L/min). CONCLUSIONS: The high frequency oral oscillation device can be used as an assist for the air way clearance therapy during mechanical ventilation.
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