2004 OPEN FORUM Abstracts
A BENCH EVALUATION OF THE RESPIRTECH PRO™ DISPOSABLE PEDIATRIC AUTOMATIC RESUSCITATOR PROTOTYPE.
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.