1 / 32

Das vermeidbare barotrauma technische lösungen

Das vermeidbare barotrauma technische lösungen. 10 Mai 2009 J P Mulier MD PhD Sint Jan Brugge-Oostende, Belgium. Announcement of interference. J P Mulier developed a ventilator safety valve Safety frog is now on sale through MedecBenelux Receives a payment on sales.

guiliaine-connor
Download Presentation

Das vermeidbare barotrauma technische lösungen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Das vermeidbare barotrauma technische lösungen 10 Mai 2009 J P Mulier MD PhD Sint Jan Brugge-Oostende, Belgium 10 mai 2009 DAC vermeidbare barotrauma JPM

  2. Announcement of interference J P Mulier developed a ventilator safety valve Safety frog is now on sale through MedecBenelux Receives a payment on sales 10 mai 2009 DAC vermeidbare barotrauma JPM

  3. A. Barotrauma is it possible today? • A. Ventilators today are relative save: • Pressure alarms on circuit • Pressure limitation on ventilation modes • Maximum pressure 70 CMH20 10 mai 2009 DAC vermeidbare barotrauma JPM

  4. Barotrauma is possible today! • A. Ventilators today are not save if: Anaesthesiologist not vigilant or not around • Pressure alarms on circuit • Alarm can be set very high ! • Pressure limitation on ventilation modes • Limit level can be set very high ! • Maximum pressure 70 CMH20 • 70 cmH20 gives barotrauma ! Anaesthesiologist uses wrong settings 10 mai 2009 DAC vermeidbare barotrauma JPM

  5. Most common accidentis a human error • Manual system is outside electronic ventilator and less protected • Forgetting to switch from manual to mechanical ventilation might happen • with a closed APL valve • with a high fresh gas flow • More frequent than reported ! 10 mai 2009 DAC vermeidbare barotrauma JPM

  6. 2 and 3 liter breathing bags • US EUR old rubber 10 mai 2009 DAC vermeidbare barotrauma JPM

  7. Compliance of breathing bags 10 mai 2009 DAC vermeidbare barotrauma JPM

  8. ventilator If you use large compliant balloons No risk of barotrauma on manual or mechanical ventilation But is prolonged alveolar distension at pressure between 20 and 50 cmH20 dangerous ? 10 mai 2009 DAC vermeidbare barotrauma JPM

  9. Effect of 30 cmH20 during 4 x 30 secondsin rats data JPMulier 2008 2009 • Without safety valve With safety valve 0 RBC 10 mai 2009 DAC vermeidbare barotrauma JPM

  10. Effect of 30 cmH20 during 4 x 30 secondsin rats data JPMulier 2008 Burkitt chamber count of BAL • Without safety valve With safety valve 0 RBC 11 RBC 10 mai 2009 DAC vermeidbare barotrauma JPM

  11. Thoughts on the pulmonary blood-gas barrier. West J B. Am J Physiol Lung Cell Mol Physiol. 2003 Sep;285(3):L501-13. • High lung volume rather than the increased alveolar pressure gives the increased permeability. Hernandez LA. J Appl Physiol. 1989;66:2364-2368. • If we increase lung volume while maintaining a constant capillary transmural pressure, the number of both endothelial and epithelial breaks is greatly increased. Fu Z. J Appl Physiol. 1992;73:123-133. 10 mai 2009 DAC vermeidbare barotrauma JPM

  12. Specifications of VSV 3 (safety frog) • Alarm and valve open when: • > 75 cmH2O • > 20 CMH2O and >6 seconds • VSV off • Variation less than 2 cmH2O and >60 seconds • VSV on • > 10 cmH2O 10 mai 2009 DAC vermeidbare barotrauma JPM

  13. Ventilator safety valve (safety frog) 10 mai 2009 DAC vermeidbare barotrauma JPM

  14. B. Barotrauma is it possible today? • B. Oxygen therapy is relative save: • Tracheotomy mask is open • Nasal canula is open • Oxygen Mask is open • Intranasal, intra pharyngeal, intratracheal canula is dangerous! • Jet therapy with canula is dangerous if tip not visualised 10 mai 2009 DAC vermeidbare barotrauma JPM

  15. What is the problem ? • Patient is intubated with endotracheal tube, laryngeal mask, wendeltube, tracheocanule • Breathing spontaneous but Patient needs oxygen • What oxygen equipment is used? • What connection is used? 10 mai 2009 DAC vermeidbare barotrauma JPM

  16. Barotrauma is possible today! • B. Oxygen therapy is not save if: • Oxygen Mask is used with LMA • Oxygen mask is used with OTT • Oxygen mask is used with NTT • Oxygen mask is used with … 10 mai 2009 DAC vermeidbare barotrauma JPM

  17. Oxygen Mask and LMA • Different connection size now but!!!! • Ideal is using a ventilator • with spontaneous breathing • With CPAP, assist,… • Never self constructed systems! 10 mai 2009 DAC vermeidbare barotrauma JPM

  18. Oxygen Mask and OTT NTT • Different size now but !!!! • Tubing might be connected directly • The inventive capacity of anesthesiologists, anesthesia nurses, post anesthetic nurses is dramatic. 10 mai 2009 DAC vermeidbare barotrauma JPM

  19. Why is Barotrauma possible ? • Bottle expanders are used to reduce 200 bar to 5 bar. • Hospital pipe line is at 5 bar • Oxygen valve reduces the pressure from 5 bar without reduction system! • If oxygen mask tube is occluded pressure can rise to 5 bar! = 5000 cmH20 10 mai 2009 DAC vermeidbare barotrauma JPM

  20. O2 mask • Used 99% on patients • not intubated, no tracheacanule,.. • Used by many different non anesthesia disciplines • Not aware of barotrauma risk • Used everywhere in the hospital like emergency, intensive care, post and per operative care, pneumology, coronary care unit, neuro high care, maternity, pediatry, neonatology, every ward, and outside the hospital: pre hospital ambulance, interhospital transfer, helicopter service, fireman,…. 10 mai 2009 DAC vermeidbare barotrauma JPM

  21. Why dangerous? • Risk of sudden/unknown connection by • Inexperienced health care worker who wants to improve O2 delivery • patient movement • Selfmade adaptation to keep O2 mask connected but risk for occlusion • Oxygen/air supply is standard not protected and connect to hospital supply at 5 bar. • 5 bar = 5 160 cmH20 ! • Connections and tubing are standard not protected and disrupt only above 2 bar • 1 bar = 1 000 cmH20 ! 10 mai 2009 DAC vermeidbare barotrauma JPM

  22. What is safe? • Nasal tips are fixed on tubing. • Safe as not connectable to other equipment. • tube fixed at connector open at end • Oxygen mask sometimes deconnectable • Tubing used for other oxygen applications! 10 mai 2009 DAC vermeidbare barotrauma JPM

  23. Who is responsible? • Oxygen supply installer ? • Not mentioned to use it in this way • Oxygen therapy equipment? • Only made for open systems, not for intubated patients • Physician requiring O2 therapy or nurse using equipment in the wrong way Patient gets the trauma 10 mai 2009 DAC vermeidbare barotrauma JPM

  24. Can we put a pressure relief valve on the oxygen supply? 10 mai 2009 DAC vermeidbare barotrauma JPM

  25. Equipment • Does equipment exists for oxygen therapy in intubated patients? • Yes oxygen cap for trachea canule • Yes ventilators but not mentioned for spontaneous breathing without assist • The spontaneous breathing circuit of anesthesia ventilator is not protected either! • Ventilator too expensive not to use as pure oxygen supply • Self made equipment • Self made safety protection? • No special equipment available. 10 mai 2009 DAC vermeidbare barotrauma JPM

  26. Special equipment to develop? • To use only on intubated patients, tracheo canule, LM ,… patients? • Risk remains when classical mask is used • Protect every oxygen supply? • Pressure to high ? For high flow • Protect every standard O2 line from O2 mask, tracheo masks,…at the end • Will every company use this protection? 10 mai 2009 DAC vermeidbare barotrauma JPM

  27. New developed barotrauma valve • Protects every oxygen supply • Should be build in • Use regular tube for flow up to 10 l/min • Use larger size tube for flow up to 20 l/min 10 mai 2009 DAC vermeidbare barotrauma JPM

  28. No barotrauma Risk volutrauma remain ! Pressure flow relation with new barotrauma valve 10 mai 2009 DAC vermeidbare barotrauma JPM

  29. Conclusion: How to protect • Protect all oxygen supply with a low pressure sensitive device • Keeps pressure below 40 cm H20 • Signals problems with alarm • Use max 6 l oxygen / minute • More is lost trhough barotrauma valve • Use large tubing for higher flow • Ambu, masks with reservoir,… Or use small inexpensive safety frog also for oxygen supply ? 10 mai 2009 DAC vermeidbare barotrauma JPM

  30. Conclusion • Ventilator • Barotrauma nicht möglich • Aber volutrauma ist möglich • Brauchen sie ein ventilator safety valve: safety frog • O2 Therapy • Barotrauma ist ein risiko • Brauche sie ein baroprotector oder ein voluprotector on jeden O2 punkt 10 mai 2009 DAC vermeidbare barotrauma JPM

  31. More information • Jan.Mulier@azbrugge.be • www.publicationslist.org/jan.mulier • European society for peri operative care of the obese patient www.espcop.org 10 mai 2009 DAC vermeidbare barotrauma JPM

  32. Scientific meeting 10 mai 2009 DAC vermeidbare barotrauma JPM

More Related