Shortcomings of Using Two Jet Nebulizers in Tandem with an Aerosol Face Mask for Optimal Oxygen Therapy

Foust, Gregory N.; Potter, William A.; Wilons, Michael D.; Golden, Emmel

doi:10.1378/chest.99.6.1346

Cited by 10 publications

(6 citation statements)

References 11 publications

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“…(8,14) Mannequin studies do not present these shortcomings, but they reproduce human anatomy very poorly. (10,11) The use of a cadaveric head and neck formalin-preserved specimen, designed in such a way that upper airway patency (including maxillary sinuses) was preserved, allowed us to study various ventilatory conditions in a model close to in vivo anatomy. We chose a model with half-opened mouth as oral breathing is predominant in patients with respiratory failure; (9) nevertheless FiO 2 values may be higher using the Ncan or Ncath in a model with closed mouth.…”

Section: Discussionmentioning

confidence: 99%

“…(7)(8)(9) An 8.5-mm endotracheal tube (Hi-Lo™; Mallinckrodt Medical; Athlone, Ireland) was inserted into the distal extremity of the trachea and connected to a piston pump (Harvard ® model 613; Ealing; Les Ulis, France) using a Y-shaped connection device. (10,11) A 257-mm low-resistance glass filter (Type A/E GelmanSciences; Ann Arbor; MI) was placed between the endotracheal tube and the electrochemical oxygen analyzer (O 2 MAXTEC™, OM25ME-AIROX; BioMS; Salt Lake City, USA). The latter device had a 90% response time of Ͻ15 sec for the final value, 1% accuracy at full scale.…”

Section: Anatomical Modelmentioning

confidence: 99%

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Influence of Jet Nebulization and Oxygen Delivery on the Fraction of Inspired Oxygen: An Experimental Model

Caille

Ehrmann²,

Boissinot³

et al. 2009

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Section: Discussionmentioning

confidence: 99%

Section: Anatomical Modelmentioning

confidence: 99%

Influence of Jet Nebulization and Oxygen Delivery on the Fraction of Inspired Oxygen: An Experimental Model

Caille

Ehrmann²,

Boissinot³

et al. 2009

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…38,39 If the FiO 2 delivered was suboptimal, this simple fact could have explained the difference reported. 16 In acute respiratory failure, similarly to invasive ventilation, NIV improves oxygenation by: delivering high oxygen concentration, unloading respiratory muscle efforts, recruiting alveoli, and increasing lung volumes. 34 By recruiting alveoli, positive pressure ventilation not only enhances lung volume (the store) but it also reduces true shunt.…”

Section: Niv As a Preoxygenation Methodsmentioning

confidence: 99%

“…Foust et al provided us information on that interesting challenge. 16 Using a laboratory model, they quantified the dilutional effects of hyperventilation on alveolar O 2 concentrations. With a tidal volume of 600 mL and a respiratory rate of 30 breaths per minute, a 100% face mask with 2 jet nebulizers (12 L/min drive on each) resulted in a delivered distal airway O 2 concentration of less than 60%.…”

Section: The Importance Of the Kind Of Bags And Oxygen Delivery Devicesmentioning

confidence: 99%

Use of Noninvasive Ventilation to Improve Pre-oxygenation Before Intubation of Hypoxemic Patients

Baillard

Solis

2009

Clinical Pulmonary Medicine

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Critically ill patients are predisposed to severe oxyhemoglobin desaturation during intubation due to many factors, including the limited physiologic oxygen reserve and the high complexity of intubation. In the intensive care unit, the usual preoxygenation is marginally effective especially in hypoxemic patients. In this short review, we discuss controversies surrounding preoxygenation in hypoxemic critically ill patients. Noninvasive ventilation (NIV), as a preoxygenation method, increases both the contents (FAO 2 ) and the container (functional residual capacity) and could be viewed as one of the best ways to enhance the oxygen stores before apnea. A short application (3 min) of NIV is more effective at reducing arterial oxyhemoglobin desaturation than using a non-rebreather bag-valve mask with reservoir in hypoxemic patients. The impact of NIV on morbidity or mortality is currently being investigated. Careful analysis of the risks and benefits on individual basis should hence be made until further studies are available for the intensivist dealing with hypoxemic critically ill patients. (Clin Pulm Med 2009;16: 270 -274) P reoxygenation allows patient to tolerate longer periods of apnea during the intubation procedure performed under anesthesia. When a difficult airway management occurs, preoxygenation protects against hypoxemia and its potential deleterious consequences. The rate of oxyhemoglobin desaturation mainly depends on the amount of the oxygen stored at the onset of the apnea. Usual preoxygenation (3 minutes of spontaneous ventilation with bag and mask with 100% O 2 ) is recommended in delaying arterial desaturation during the apnea related to endotracheal intubation (ETI) procedures. 1 In healthy apneic adult patient, the time course to reach SpO 2 Ͻ90% after 3 minutes preoxygenation is about 8 minutes. Numerous factors are involved in the oxygen loading process during the preoxygenation such as those able to interfere with alveolar, arterial, tissue, and venous compartments and those interacting with the delivered FiO 2 . The extent of oxyhemoglobin desaturation also depends on the duration of apnea which correspond to the time elapsed between the onset of apnea and successful intubation with the subsequent oxygen provision. The difficulties encountered during airway management prolong the duration of apnea. Finally, the capacity for oxygen loading and the condition of intubation will be the determinants of the efficiency of preoxygenation. PREOXYGENATION IN CRITICALLY ILL PATIENTS: WHAT IS THE MATTER?To consider the factors affecting the rate of oxyhemoglobin desaturation during apnea, Farmery and Roe developed a model. 2 Of note, this model was adapted to a postoperative scenario to predict the consequences of such a nonphysiological condition on the time course of arterial oxyhemoglobin desaturation. The authors stated that it represented to some extent a worst-case scenario in which the combined effect of hypovolemia (4 L), reduced cardiac output (4 L/min), anemia (10 g/dL), increased V/Q misma...

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“…This is especially critical with a face mask with an open design, no gas reservoir, and outlet holes, through which room air can easily be secondarily entrained. [17][18][19] We have observed this problem in recently extubated patients who were placed on similar masks with standard large-volume aerosol nebulizers. Failure of the system to meet patient inspiratory flow demand and allow secondary room air entrainment at the mask has been interpreted as patient deterioration.…”

mentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen in Critically Ill Adults: Do the Nose or Lungs Know There's a Difference?

Wattier

Ward

2011

Respir Care

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Shortcomings of Using Two Jet Nebulizers in Tandem with an Aerosol Face Mask for Optimal Oxygen Therapy

Cited by 10 publications

References 11 publications

Influence of Jet Nebulization and Oxygen Delivery on the Fraction of Inspired Oxygen: An Experimental Model

Influence of Jet Nebulization and Oxygen Delivery on the Fraction of Inspired Oxygen: An Experimental Model

Use of Noninvasive Ventilation to Improve Pre-oxygenation Before Intubation of Hypoxemic Patients

High-Flow Nasal Cannula Oxygen in Critically Ill Adults: Do the Nose or Lungs Know There's a Difference?

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