Abstract
Background:
Metaneb intrapulmonary percussive ventilation device is utilized in pediatric patients as an airway clearance therapy used to clear secretions and promote lung expansion. Often, patients who need Metaneb therapy are also on non-invasive support. We aimed to evaluate if the Metaneb device could be used in line with NIV or NIV mask in an effort to maintain patient comfort, reduce circuit disconnections, and, reduce the number of mask readjustment in our pediatric population.
Methods:
A Philips Respironics V60 Ventilator was connected via Philips XXS Performax facemask with disposable exhalation port (DEP) to the Michigan Instruments infant head and test lung equipped with Pneuview 3 software. The V60 was set up in S/T mode 10/5, RR10, Ti0.6s, Rise 1, 21% for a simulated 10 kg patient. Initial control values were obtained and verified. The Hill-Rom Metaneb (Frequency high, black occlusion ring) was then interfaced with a spring-T at the dry side of the heater, between the mask and DEP, and directly to the Performax mask (3rd blue occlusion ring, no NIV). Volume, pressures and leak were obtained from the Pneuview3 software and V60 over three minutes and averaged. Placement and efficiency of the Metaneb were evaluated.
Results:
When evaluating the three bench models based on pressure delivered the Metaneb direct to NIV mask created the highest pressure with an average measured PIP of 13.4 cm H2O. The Metaneb between the mask and circuit created the most PEEP with an average of 2.3 cm H2O. Placing the Metaneb at the dry side of the heater showed the largest volumes delivered to the patient with an average of 24.23mL. Subjectively observed chest oscillations was appreciated best when connecting the Metaneb device directly to the NIV mask, then in the dry side of the heater, followed by the tee directly before the mask. See Table 1 and image 1 for detailed results.
Conclusions:
Metaneb therapy can be administered in conjunction with NIV effectively without removing and replacing the patient interface. In our bench model, when attempting to reduce NIV interface disconnections Bench Model B (Metaneb in-between NIV mask and NIV Circuit) is the most appropriate way to interface these two therapies. Further studies must be done to appreciate the treatment efficacy with each of these models.
PneuView 3 Measurements for Bench Model Comparison
VT (mLs)
PIP (cmH20)
PEEP (cmH20)
Control (NIV w/ Non-Vented Mask)
11.4
9.8
4.5
14.7
10
5
13.8
10.2
5.1
Control Average
13.3
10
4.86
Bench Model A (Metaneb at dry side of heater)
24.2
11.2
2.2
24.7
13
2
23.8
11.5
2.1
Bench A Average
24.2
11.9
2.1
Bench Model B (Metaneb between mask and circuit)
17.9
9.8
1.9
15
9.9
2.3
16.9
9.3
2.4
Bench B Average
16.6
9.6
2.3
Bench Model C (Direct to mask)
10
13.5
2.2
9.7
13.3
2.3
9.6
13.4
2.2
Bench C Average
9.7
13.4
2.2
These pictures display the PneuView 3 graphics diaplyed at each of the three bench model comparisons.
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