The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

MAXIMIZING OXYGEN DELIVERY WITH AN OXYGEN CONCENTRATOR DURING MECHANICAL VENTILATION

Dario Rodriquez1,Thomas Blakeman2, Richard Branson2; 1CSTARS (Center for Sustainment ofTrauma and Readiness Skills), University Hospital, Cincinnat, OH; 2Surgery, University of Cincinnati, Cincinnati, OH

Background: Transportation of the critically ill/injured warfighter requires the coordinated care and judicious use of resources. Availability of oxygen (O2) supplies for the mechanically ventilated patient is crucial. Size and weight of cylinders makes transport difficult and presents an increased risk of fire. A proposed solution is to use a portable oxygen concentrator (POC) for mechanical ventilation. We tested the Sequal Eclipse II POC paired with the Impact 754 and Pulmonetics LTV-1200 ventilators in the laboratory and evaluated the fraction of inspired oxygen (FIO2) across a range of minute volumes. Methods: Each ventilator was attached to a test lung (TTL) and pressure, volume, flow, and inspired oxygen (FIO2) was measured by a gas/flow analyzer. Ventilators were tested at a tidal volume (VT) of 500 ml, inspiratory time of 1.0 second, respiratory rates of 10, 20, and 30 breaths/minute, and PEEP of 0 and 10 cmH2O. The LTV 1200 was tested with and without the expiratory bias flow. The Eclipse II was modified to provide pulse dosing on inspiration at three volumes (64,128,192 ml) and continuous flow at 1-3 liters/minute. Six combinations of ventilator settings were used with each POC setting for evaluation. O2 was injected at the ventilator gas outlet and patient wye for pulse dose and continuous flow. Additionally, continuous flow O2 was injected into the oxygen inlet port of the LTV 1200, and a reservoir bag, on the inlet port of the Impact 754. All tests were done with both ventilators using continuous flow, wall source O2 as a control. We measured the FIO2 with the concentrator on the highest pulse dose setting while decreasing ventilator tidal volume to compensate for the added volume. Results: The delivered FIO2 was highest when oxygen was injected into the ventilator circuit at the patient wye using pulse dosing, with the VT corrected. The next highest FIO2 was with continuous flow at the inlet (LTV), and reservoir (Impact). Electrical power consumption was less during pulse dose. Conclusion: The relatively high FIO2 delivered by the POC makes this method of O2 delivery a viable alternative to O2 cylinders. Patients requiring an FIO2 of 1.0 would require additional compressed oxygen. This system allows O2 delivery up to 76% solely using electricity. An integrated ventilator/POC capable of automatically compensating VT for POC output is desirable. Further patient testing needs to be done to validate these laboratory findings. Sponsored Research - None

*O2 conserve on #Tidal volume corrected for pulse dose volume Pulse dose of 192 ml

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