Performance of EasyBreath^® Decathlon Snorkeling mask for Delivering Continuous Positive Airway Pressure

Abstract

Background: During the COVID-19 pandemic, the need for noninvasive respiratory support devices has dramatically increased, sometimes exceeding hospital capacity. The full-face Decathlon snorkeling mask, EasyBreath® (EB® mask), has been adapted to deliver continuous positive airway pressure (CPAP) as an emergency respiratory interface. We aimed to assess the performance of this modified EB® mask. Methods: CPAP set at 5, 10, and 15 cmH2O was delivered to 10 healthy volunteers with a high-flow system generator set at 40, 80, and 120 L min-1 and with a turbine-driven ventilator during both spontaneous and loaded (resistor) breathing. Inspiratory CO2 partial pressure (PiCO2), pressure inside the mask, breathing pattern and electrical activity of the diaphragm (EAdi) were measured at all combinations of CPAP/flows delivered, with and without the resistor. Results: Using the high-flow generator set at 40 L min-1, the PiCO2 significantly increased and the system was unable to maintain the target CPAP of 10 and 15 cmH2O and a stable pressure within the respiratory cycle; conversely, the turbine-driven ventilator did. EAdi significantly increased with flow rates of 40 and 80 L min-1 but not at 120 L min-1 and with the turbine-driven ventilator. Conclusions: EB® mask can be safely used to deliver CPAP only under strict constraints, using either a high-flow generator at a flow rate greater than 80 L min-1, or a high-performance turbine-driven ventilator.

Overview of the User Experience for Snorkeling Mask Designs during the COVID-19 Pandemic

“…In this work, the snorkel mask also demonstrated a higher CO 2 accumulation (25 mmHg, ~3%) compared to the CPAP mask (5 mmHg, ~0.6%). Similarly, Alberto Noto analyzed the efficiency of an EasyBreath ® mask as an emergency respiratory interface for a CPAP system [ 40 ]. The authors studied the stability of pressure generated inside the mask with and without a turbine-driven ventilator.…”

“…This is particularly true for the use of MM as NIV devices. Indeed, as highlighted by Noto et al [ 40 ]: “The modified mask should be used for emergency use to deliver CPAP only under strict constraints, using a high-flow generator at a flow rate greater than min −1 , 80 L or with a high-performance turbine-driven ventilator”.…”

“…In this case, a 3D-printed valve connects the mask to a standard non-invasive ventilation system working with either a bilevel or continuous positive airway pressure (BPAP or CPAP mode, respectively) [ 40 , 41 ]. Such a retrofitted device has been proposed to help non-critical patients, leaving the use of invasive ventilators for the most critical patient cases [ 40 ]. Figure 1 summarizes the different user strategies proposed for snorkeling mask use in health care.…”

“…In addition, the use of full-face snorkeling masks as non-invasive ventilation (NIV) devices for patient oxygenation (ventilation) has been reported [37][38][39]. In this case, a 3D-printed valve connects the mask to a standard non-invasive ventilation system working with either a bilevel or continuous positive airway pressure (BPAP or CPAP mode, respectively) [40,41]. Such a retrofitted device has been proposed to help non-critical patients, leaving the use of invasive ventilators for the most critical patient cases [40].…”

Do responses to the COVID-19 pandemic anticipate a long-lasting shift towards peer-to-peer production or degrowth?

“…However, laboratory-based tests (using healthy volunteers) of this improvised solution found it to provide a viable emergency substitute in only limited contexts. The percentage of inspired oxygen was consistently lower, and the level of carbon dioxide accumulation was higher, with the adapted snorkel masque compared to a standard CPAP masque ( Landry et al., 2020 ; Noto et al., 2020 ). Furthermore, the use of higher delivery pressures resulted in excessive leakage from the forehead seal, which would present a risk of spreading aerosolised virus from an infected patient ( Landry et al., 2020 ).…”