Abstract
Background:
Intrapulmonary Percussive Ventilation (IPV) is pneumatically powered; high frequency short bursts of gas applied at the airway opening. The Percussionaire (P ) IPV is a device used in the pediatric population to aid in the removal of retained airway secretions and atelectasis. In an effort to reduce VAP, bedside providers aim to limit circuit disconnections. The current disposable (P ) circuit and adapter require the circuit to be disconnected or a large adapter to remain inline which can be cumbersome in the pediatric population. A bench evaluation was conducted to assess the performance of the (P ) IPV with the circuit placed in the proximal position (requiring increased dead space or disconnection) and in the distal position with an adapter allowing for no disconnection.
Methods:
A Maquet Servo-i was calibrated and a circuit test was completed. The ventilator was set up with a Fisher and Paykel RT 280 circuit in adult category with the following vent settings: PRVC VT 120 R20 PEEP10 TI 0.7 FIO221%. The high-pressure limit was set at 60 cm H2O and all other alarms were set at min/max to reduce nuisance alarms. A Michigan Test Lung was utilized with a compliance of 0.04 and a resistor of RP20. A Philips NM3 with pediatric adapter interfaced the bench model directly between the test lung and ventilator circuit. A (P ) IPV-1C was set with a driving pressure of 30 cm H2O, percussion rate of 12 (full easy) with a Phasitron 5 circuit (P5C). The Phasitron T pop off was set at 40 cm H2O. Three positions of IPV placement in line with the circuit were analyzed. Position A included placing the P5C in line with the F&P circuit and IPV Phasitron T at the junction between the inspiratory limb and circuit wye. Position B included placing the P5C in line with the F&P circuit using a continuous neb adapter and a spring-T at the dry side of the heater. Position C included placing the P5C in line with the F&P circuit using the Phasitron T at the dry side of the heater. Control values were obtained prior to the insertion of the IPV device. In each position, the results were recorded three times over three minutes and averaged.
Results:
See Table 1 for detailed results.
Conclusions:
In the adult circuit bench model, Position C provided the more comparable and reproducible results to the control. In the infant model, Position A provided the most comparable and reproducible results. Further studies must be done to evaluate the treatment efficacy in these models.
Each value shows the average over three identical trials. View all access options for this article.IPV Bench Model Comparisons
ADULT CIRCUIT
Phasitron Tee deadspace= 27mL, Spring Tee deadspace= 20mL
Total PEEP (cmH20)
PIP (cmH20)
MV (L/min)
Vti (mL)
Vte (mL)
Servo I Control
10
22
1.9
112
104
Position A (IPV at wye w/ phasitron tee)
12 (STD 1.41)
17.3 (STD 3.32)
7.5 (STD 3.95)
201 (STD 62.93)
163.7 (STD 42.21)
Position B (IPV at heater w/ spring tee)
14.3 (STD 3.04)
23.3 (STD 0.91)
9.9 (STD 5.65)
371.7 (STD 193.63)
322.3 (STD 154.36)
Position C (IPV at heater w/ phasitron tee)
12 (STD 1.41)
17.3 (STD 3.32)
7.1 (STD 3.67)
182.6 (STD 49.9)
136.3 (STD 22.83)
INFANT CIRCUIT
Adapters used from circuit, NIF-T, Bag Adapter- total deadspace= 45mL
Servo I Control
10
14
1.9
115
96
Position A (IPV at wye w/ phasitron tee)
14.6 (STD 3.25)
18 (STD 2.82)
7.9 (STD 4.24)
166 (STD 36.06)
65.6 (STD 21.49)
Position B (IPV at heater w/ spring tee)
22 (STD 8.48)
28 (STD 9.89)
9.3 (STD 5.23)
334.3 (STD 155.06)
216.3 (STD 85.06)
Position C (IPV at heater w/ phasitron tee)
11.3 (STD 0.91)
15 (STD 0.70)
6.2 (STD 3.04)
39.6 (STD 53.31)
63 (STD 23.33)
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