The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

EFFECTS OF ADDING PEEP AND OXYGEN FLOW ON DELIVERED FIO2 IN THE IPV BREATHING CIRCUIT.

Jared B. Rice, Chad E. Weagraff, Nancy A. Johnson, Kathleen M. Deakins, Timothy R. Myers, John T. Gallagher; Pediatric Respiratory Care, University Hospitals - Rainbow Babies and Children's Hospital, Cleveland, OH

Background: Intrapulmonary Percussive Ventilation (IPV) is an airway clearance modality designed to enhance the removal of secretions, resolve atelectasis and improve ventilation and oxygenation using high frequency, low volume positive pressure breaths delivered to the airway via a percussionator. The IPV 1C (Percussionaire, Sandpoint Idaho) is pneumatically driven by a 100% FiO2, 50 psi gas source gas, with an estimated FiO2 delivered at 21-80%. An external positive end expiratory pressure (PEEP) valve can be added to increase baseline and mean airway pressure during the treatment. The IPV 1C utilizes an entrainment port that dilutes delivered FiO2 at the patient connection. The purpose of this study was to determine if adding an external PEEP valve or a tubing reservoir with additional oxygen flow has an effect on the delivered FiO2. Methods: A 0.5L Breathing Bag (GE; Vital Signs) was connected to the distal end of IPV breathing manifold, Oxygen concentration was measured using an Analytical Industries Inc. All 2000M oxygen monitor (calibrated to 21% and 100%) at the patient connection, with a PEEP of 0, +5 and +10 cmH2O; and when adding a 50mL corrugated tubing reservoir with 5 LPM & 10 LPM of oxygen flow to the entrainment port of the IPV breathing circuit. Data were collected in raw values representing percent FiO2 mean values and standard deviation at 0,+5 and +10 cmH2O PEEP with 0, 5, 10 LPM bleed-in oxygen. ANOVA tests were used to determine the significance of change in FiO2 as both PEEP and bleed-in levels were changed. Results: There is a significant difference in delivered FiO2 between PEEP levels in each category of oxygen bleed-in (p < 0.001). Likewise, the delivered FiO2 changed significantly as the amount of oxygen bleed-in was increased, regardless of the amount of PEEP being used (p < 0.001). Conclusions: In situations where high FiO2 is needed, adding oxygen flow to the IPV IC breathing circuit air entrainment port, with or without an external PEEP valve attachment increases FiO2 better than adding external PEEP alone.
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Measured mean and standard deviation (SD) values for % FiO2 when adding oxygen flow via reservoir and PEEP to an IPV breathing circuit.