Positive Expiratory Pressure Oxygen Therapy (PEP- OT): Innovation in acute respiratory support

Abstract

Respiratory support is commonly required in emergency department and hospitalized patients. Standard oxygen therapy through nasal prong or face mask administers high oxygen concentration, but does not have any effect on physiological alterations of alveolar collapse and work of breathing. High flow nasal canula (HFNC) and continuous positive airway pressure (CPAP) devices offer mechanical benefits with improvement in functional residual capacity along with oxygen therapy, but need expensive equipment. We developed a novel oxygen delivery device which combines beneficial effects of positive expiratory pressure with oxygen therapy. Positive expiratory pressure oxygen therapy (PEP-OT) device is prepared by using commercially available positive end-expiratory pressure (PEEP) valve, air-tight face mask and oxygen reservoir from a non-rebreathing mask attached via a T-/Y-connector. Typically, air-flow should be slightly more than minute volume and initial PEEP is set at 5-7 cm of water. PEP-OT offers a low-cost, light-weight device which can be useful even in remote areas where electricity might not be available. It could potentially be an alternative to HFNC and CPAP therapy in patients requiring acute respiratory support. With unprecedent demand of respiratory equipment in COVID-19 pandemic, PEP-OT could be an attractive alternative respiratory support.