Lamb Keith, Piper David
Respiratory Care Services, Iowa Methodist Medical Center, De Moines, Iowa, USA.
Can J Respir Ther. 2016 Winter;52(1):13-5.
The non-rebreather mask (NRBM) is used for many applications and in many patient care scenarios in which hypoxemia and resultant hypoxia are a concern. The NRBM is a low-flow oxygen delivery system that is easily deployed and capable of delivering a relatively high fraction of inspired oxygen (FiO2).The potential for ineffective carbon dioxide (CO2) removal at low flow rates is a safety concern.
The authors hypothesized that the use of an OxyMask (Southmedic Inc, Canada) would mitigate these safety concerns while still delivering a relatively high FiO2.
Bench studies were performed in a third-party laboratory by qualified engineers (Piper Medical, USA). A Harvard Respirator Pump (Harvard Apparatus, USA), oxygen source, CO2 source and a mannequin head were used to simulate varying respiratory conditions. End tidal CO2 (EtCO2), FiO2, fraction of inspired CO2 and percent drop in CO2 in the first second of exhalation were measured at different mask flow rates and respiratory rates. There were two categories of flow rates: high-flow (15 L/min) and low-flow (2 L/min). In each flow group, the above parameters were measured using a tidal volume of 400 mL, inspiratory/expiratory ratio of 1:2, EtCO2 of 5% and a breathing frequency of 15, 20 or 24 breaths/min. Mask performance measurements were obtained and compared.
The OxyMask outperformed the traditional NRBM in each tested category. There was a higher inspired oxygen level, lower inspired CO2 level, and more efficient CO2 clearance at each mask flow level and simulated patient minute volume. This was especially true during conditions in which there were very low mask flow rates.
非重复呼吸面罩(NRBM)用于许多情况以及众多存在低氧血症及由此导致的缺氧问题的患者护理场景中。NRBM是一种低流量氧气输送系统,易于部署,能够输送相对高比例的吸入氧分数(FiO2)。低流速时二氧化碳(CO2)清除无效的可能性是一个安全问题。
作者推测使用OxyMask(加拿大Southmedic公司)将减轻这些安全问题,同时仍能输送相对较高的FiO2。
由合格工程师(美国Piper Medical公司)在第三方实验室进行实验台研究。使用哈佛呼吸器泵(美国哈佛仪器公司)、氧气源、二氧化碳源和一个人体模型头部来模拟不同的呼吸状况。在不同的面罩流速和呼吸频率下,测量呼气末二氧化碳(EtCO2)、FiO2、吸入二氧化碳分数以及呼气第一秒内二氧化碳下降百分比。有两类流速:高流量(15升/分钟)和低流量(2升/分钟)。在每个流量组中,使用400毫升潮气量、1:2的吸呼比、5%的EtCO2以及15、20或24次/分钟的呼吸频率来测量上述参数。获得并比较面罩性能测量结果。
在每个测试类别中,OxyMask的表现均优于传统的NRBM。在每个面罩流速水平和模拟的患者分钟通气量下,吸入氧水平更高,吸入二氧化碳水平更低,二氧化碳清除效率更高。在面罩流速非常低的情况下尤其如此。