2004 OPEN FORUM Abstracts
A BENCH EVALUATION OF THE RESPIRTECH PRO™ DISPOSABLE PEDIATRIC AUTOMATIC RESUSCITATOR PROTOTYPE.
William J.
Jackson, RCT, RRT; Lysa Kinoshita, RCP, RRT; Shriners Hospitals
for Children Northern California; Sacramento, California.
The
RespirTech Pro™
is a single patient use disposable automatic resuscitator designed
for internal transports. It is a pneumatic, pressure-cycled
ventilator which can be connected to either a high-pressure gas
source or flowmeter and is limited to a maximum flow rate of 40
liters per minute. It is constructed of plastic with an emergency
pop off set at 60 cmH2O. The device has two adjustment
knobs, which set Inspiratory Pressure between 20-50 cmH2O
and Expiratory Time. While positive end expiratory pressure is not
adjustable, the manufacturer states that it will be approximately 10%
of the Positive Inspiratory Pressure. Inspiratory Time is dependent
on flow rate and Peak Inspiratory Pressure (PIP). This device was
tested to see if the PIP and Respiratory Rate respiratory rate would
remain stable once set.
During
the bench testing the device was tested with a standard 15 liter per
minute flowmeter, with the flow rate set at 15 liters per minute, and
a high-flow flowmeter set at 20 and 25 liters per minute. The Peak
Inspiratory Pressure was tested at 15, 20, 25 cmH2O with a
target respiratory rate of 15 breaths per minute, increasing by five
breaths per minute until the I:E ratio became inversed. The device
was connected to a standard Siemens test lung (60
06 832 E037E), and
respiratory mechanics monitoring was accomplished with Novametrix
NICO
Cardiopulmonary
Management System (Respironics). We monitored the following
parameters in real time: Respiratory Rate, Minute Volume (MV),
Inspiratory Tidal Volume (Vti), Expiratory Tidal Volume
(Vte), PIP, Mean Airway Pressure (MAP) and Positive End
Expiratory Pressure (PEEP). These parameters were recorded on a
computer for a minimum of 20 minutes. The data was then imported into
an Excel spreadsheet and each setting was analyzed for 300 breath
cycles.
The
measured respiratory mechanics revealed a fluctuating respiratory
rate 8-17 BMP (mean=11.9, SD=1.763) when tested at the set rate of 15
BPM, PIP 15 cmH2O and flow rate at 15 LPM, 12-21 BPM
(mean=16.9, SD=1.73) at settings of 15 BPM, PIP 15 cm H2O, flow rate
at 20 LPM, and 18-27 BPM (mean=22.9, SD=2.21) at 20 BPM, PIP of 15 cm
H2O and Flow rate of 20 LPM. The lowest respiratory rate possible
was limited to 19 BPM with variability between 19-26 (mean=23,
SD=1.31) when tested at PIP 20 cmH2O, flow rate 25 LPM. At
the remaining combinations of Respiratory Rate, PIP and flow rate,
Respiratory Rate (SD ranged from 0 to 1.15) remained relatively
stable. Additionally, at all settings PIP remained stable (SD ranged
from 0 to .5). The measured PEEP ranged from 16-21% of the set PIP.
The device was easy to set up and stable with the exception of the
respiratory rate variability noted above.
The
unit we tested was a prototype, not a production model. In closing,
the RespirTech Pro™
Disposable Pediatric Automatic Resuscitator appears to be a viable
alternative to a transport ventilator. The clinician must understand
that the device has no monitor or alarms and has some variability of
respiratory parameters. The patient would need to be closely
monitored.