Be'eri Eliezer, Owen Simon, Beeri Maurit, Millis Scott R, Eisenkraft Arik
1Department of Respiratory Rehabilitation,Alyn Hospital,Jerusalem,Israel.
2Department of Physical Medicine & Rehabilitation,Wayne State University School of Medicine,The Rehabilitation Institute of Michigan,Detroit,Michigan.
Disaster Med Public Health Prep. 2018 Dec;12(6):739-743. doi: 10.1017/dmp.2018.3. Epub 2018 Feb 21.
Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients.
Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial.
For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator's trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators.
A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients' mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743).
化学-生物-放射-核（CBRN）防毒面具是保护普通民众免受有毒工业化合物（TICs）吸入危害的标准手段，例如在工业事故或恐怖袭击之后。然而，此类防毒面具无法保护接受家庭机械通气的患者，因为呼吸机气流会绕过CBRN过滤器。因此，我们在体内评估了在家庭呼吸机的排气口添加标准配发的CBRN过滤器的安全性，以此作为为这类患者提供TIC防护的一种方法。
八名成年患者纳入本研究。在研究前，所有患者均通过气管造口进行稳定的慢性通气至少3个月。每位患者在其呼吸机排气口连接一个标准配发的CBRN过滤罐进行1小时的通气。在使用过滤器之前、期间和之后进行生理和气流测量，并且患者在试验期间持续报告其通气的主观感受。
对于所有患者以及在整个研究过程中，未检测到任何测量的生理参数恶化，也未检测到测量的气流参数变化。与未使用CBRN过滤罐通气相比，所有患者原位使用CBRN过滤罐时通气感受无主观差异。即使对于那些自主呼吸从而激活呼吸机触发/灵敏度功能的患者也是如此。在呼吸机排气口添加CBRN过滤罐后，未发生呼吸机技术故障。
可以在长期通气患者的排气口添加CBRN过滤罐，而不会导致患者机械通气质量出现客观或主观恶化。（《灾难医学与公共卫生防范》。2018年；12:739 - 743）
