OXYMASK Reference

 

OxyMask SouthMedic

OxyMask’s logical advantages:

  • Phthalate-Free
  • The only O2 therapy device to deliver FiO2 of 24% – 90%
  • Can be utilized to deliver High Flow O2 therapy to flush
  • Zero probability of creating intrinsic PEEP on flow
    rates > 15 LPM
  • Zero probability of CO2 rebreathing on low flow rates
  • Allows open communication with your patient
  • Designed for nose and mouth breathers
  • Convenient swivel elbow to reposition tubing
  • Naso Gastric tube can be threaded through OxyMask
  • Allows for suctioning & oral care through mask
  • Open mask allows for delivery of other respiratory therapies
  • Reduces probability of aspiration

oxymask

oxymask2

Tom Piraino RRT and Deborah J Cook MD

A key limitation of mechanical ventilators is that they do not measure the Ptp or pleural pressure. Airway pres- sure alone cannot distinguish poor lung compliance from poor chest-wall compliance. High intra-abdominal pres- sure can severely impair chest wall mechanics.9,10 We used esophageal balloon manometry to estimate Ptp and guide optimal PEEP in a patient suspected of having decreased lung compliance due to intra-abdominal hypertension.

 

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Respir Care 2011 Piraino

 

The effect of increasing positive end-expiratory pressure on an atelectatic lung

Ray RitzBA RRT FAARC

Beth Israel Deaconess Medical Center

Boston MA

Pleural Pressure Measurement Hypothesis

•

Depending on the chest wall contribution to respiratory mechanics, a given PEEP level or plateau pressure may be adequate for one patient but potentially injurious for another…

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esophageal_balloon_manometry

Link

RCSW.org

Respiratory Care 2010 vol. 55 (2) pp. 162-74
Thus, the currently recommended strategy of setting

PEEP without regard to transpulmonary pressure is predicted to benefit some patients while

harming others. Recently the use of esophageal manometry to identify the optimal ventilator

settings, avoiding both under-inflation and over-inflation, was proposed. This method shows promise

but awaits larger clinical trials to assess its impact on clinical outcomes…..

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balloon

 

Methods

• In esophageal-pressure guided group, mechanical ventilation settings

determined by initial esophageal pressure measurements.

• Tidal volume set at 6ml per kg predicted body weight.

• PEEP set to achieve a transpulmonary pressure of 0-10cm H2O at end

expiration, according to a sliding scale based on PaO2 and FiO2 – see

figure 1.

• Also limited tidal volume to keep transpulmonary pressure <25cmH2O at

end-inspiration (limit rarely approached during study and tidal volume was

never reduced for this purpose)……..

Read Article

Mechanical Ventilation Guided by Esophageal Pressure in Acutex

GoogleDocs Link

Reference: Am J Respir Crit Care Med (2006) vol. 174 (3) pp. 268-78/ respiratoryresource.ca

 

Lung Recruitment

Assess for any auto-PEEP and make adjustments to correct before continuing

Using Pressure Control use the following settings

• Adjust high pressure alarm to 60 cm H2O

• Pressure Control (above PEEP): 15-20 cm H2O

• PEEP: 20-25 cm H2O (attempt 25 cm H2O

o Target PIP of 40 cm H2O

• iTime: 1 – 2 seconds

• Respiratory rate: needed by the patient, must have full exhalation (expired flow

of zero)

• FiO2 1.0

• Ventilate for 1-2 minutes (readjust alarm limits when the procedure is complete)

 
 

 

 

  Lung Recruitment and Decremental PEEP

 
 

 

APRV, PRVC, PAV

Current modes of ventilation explained:

APRV/PAV/PRVC/etc…

Excerpt:

    • Recruitable low compliance lung disorders
    • Lung dysfunction secondary to thoracic restriction i.e.. obesity, acites
    • Inadequate oxygenation with FiO2 > .60
    • PIP> 35 cmH2O and /or PEEP>10 cmH2O
    • Lung protective strategies (high PEEP, low Vt) are failing
  • Can be used with other interventions i.e.. INO therapy, prone positioning

  • APRV

    Airway Pressure Release Ventilation (Power Point)

    Ventilation Modes

    APRV Clinical Guide (From Respiratory Resource)

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