Advanced Settings Guidelines for Biphasic Cuirass Ventilation Start Here

Fit Cuirass Per Guidelines

Weak or Absent Respiratory Drive?

Yes

Yes

No

Does Patient Meet Criteria for BCV Intervention? (Partial list of indications below) (Exclusion Criteria page 2)

Control Mode (Proceed to setting guidelines on page 2)

Turn The Page

Utilize standard assessment measures for specific illness to determine tolerance.

Select Alternative Intervention

No

Unchanged Worse Titrate CNEP to more negative until desired clinical effect obtained. Assess response to adjusted settings

Unchanged Worse

CNEP may be used adjunctively with PPV. Respiratory drive consideration branch may be bypassed if on set RR and VT via PPV. Control mode Can be used with PPV in assisting mode with BCV rate to be greater

Initiate Continuous Negative Mode (CNEP) •Adult: -8 to -15cm Pediatric: -6 to -10cm Infant: -4 to -8cm •Extreme alveolar recruitment needs, work of breathing, or hypoxemia: -20 or more negative Assess response to initial settings

1

Improved

Reassess frequently. Titrate CNEP per clinical response. Consider standby trials when symptoms return to pre-illness baseline on -4 to -8.

Provide supplemental O2 via nasal or facial delivery devices or artificial airway as indicated to meet immediate oxygen requirements Patient with soft tissue airway obstruction can receive benefit of BCV with use of mask CPAP or airway adjunct

Partial List of Indications Respiratory Failure

Hypoxemia, V/Q Mismatch

AIDS Related Lung Disease

Neuromuscular Disease

Fatigues Easily Post Extubation

Head and Spinal Injuries

Bronchiectasis/ Cystic Fibrosis

Increased WOB/ Dyspnea

Ventilation During ENT & Bronchoscopy procedures

Problems with Weaning from PPV

Low CO State or High Potential with PPV

Chronic Obstructive Pulmonary Disease (COPD)

Asthma/Bronchiolitis/ Post Fontan/Fallot Bronchitis

Post-op/Recovery Ventilation

Cor Pulmonale

Cardiogenic Pulmonary Edema

Pulmonary Artery Hypertension

Atelectasis/ Retained Secretions

Bridge to Lung Transplant Needed

Lung Protection and/or Recruitment in high MAP/ Pplat PPV Situations

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Advanced Settings Guidelines for Biphasic Cuirass Ventilation CONTROL MODE Criteria Met (Weak or absent respiratory drive and/or CO2 retention and/or dyspnea unresponsive to CNEP titration, no exclusion criteria present)

Yes

Initiate CONTROL MODE (Select advanced control settings based on pulmonary status/disease state) Mean cuirass pressure should always be kept more negative than -4 At rates >60 Insp & Exp pressures should balance i.e. -15/+15

Keep negative to positive pressure ratios at 3:1 i.e -24/8 at f < 60 Hypoxemia: Lower MCP Hypercarbia: Higher VE

Δp should exceed 10 cm

No

Select Alternative Intervention

Sick Lung Obstructive Advanced

Inspiratory: -24 Expiratory: +8 I:E Ratio: 1:1 or 1:2 Frequency: equal to or slightly > spontaneous respiratory rate

Sick Lung Low Compliance/Low Volume-ARDS Advanced

Inspiratory: -30 Expiratory: +10 I:E Ratio: 2:1 to 6:1 Frequency: 40, 50, 60cpm up to 120cpm depending on patient to ensure adequate VE. Rates > 60 balance i.e. pressures

Sick Lung Restrictive Advanced Normal Lungs Neuromuscular conditions, ventilation during anesthesia, ventilation post cardiac surgery, low CO, Head and spinal injuries

Patients that are persistently asynchronous with Control Mode may get superior results on Respiratory Synchronized Mode

Medical Disclaimer: The content provided in Hayek Medical’s educational materials are for informative purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment by a qualified physician or healthcare provider.

Inspiratory: -21 Expiratory:+7 I:E Ratio: 1:1 Frequency: to ensure adequate VE; start at up to 60cpm (can be increased up to 120cpm for decreased chest wall compliance). Rates> 60 balance i.e. pressures Inspiratory: -21 Expiratory: +7 I:E Ratio: 1:1 Frequency: Set frequency at 2-4 breaths above patient’s own spontaneous rate.

Decrease rate and mean chamber pressure as patient status improves. If adequate resp. drive present attempt CNEP trials and monitor in CNEP protocol from page1.

Improved

Assess response to initial settings

Unchanged Worse Gradually increase Δp keeping a pressure ratio at 3:1. (e.g. change -21/+7 or - 24/+8 ) Alter I:E for greater Ti to lower mean chamber pressure

The following table indicates the relevant cuirasses to be used. Cuirass Size

Part Number

Aproximate Weight (kg)

Small Infant

0 1 2

RT-CUR00-00 RT-CUR01-01 RT-CUR02-01

1.8 - 3.5 1.8 - 3.5 3.5 - 5

Infant / Pediatric

3 4 5 6

RT-CUR03-01 RT-CUR04 -01 RT-CUR05-01 RT-CUR06-01

5-7 7 - 15 15 - 20 20 - 35

Adult

7 8 8B 9 10

RT-CUR07-01 RT-CUR08-01 RT-CUR8B-01 RT-CUR09-01 RT-CUR10-01

35 -50 50 - 75 50 - 85 75 - 90 90 +

2

Secretion Clearance Mode Produces secretion mobilization and facilitates expectoration. Useful for atelectasis and treatment in pulmonary secretion proliferative illnesses. 1. Vibration Mode (HFCWO): Shakes and thins secretions while mobilizing them to the large airways Settings: Frequency: 800cpm* Time: 3-4 minutes *decrease the frequency for thicker secretions. Increase for smaller patients. Inspiratory Pressure: -30 : decrease for smaller patients Expiratory Pressure in vibration mode are defaulted to the same as inspiratory pressures. Time: 2-4 minutes 2. Assisted Cough Mode: Assists with expectoration Settings Insp/Exp -30/+20 I:E Ratio: 4:1 or 6:1 Frequency: 24 cpm Time: 2 minutes • Increase cough pressures as needed • Completion of both modes represents one cycle of secretion clearance mode. • Each secretion clearance session should last about 20-30 minutes. • Higher pressures in cough mode e.g. -35/+35 as tolerated by the patient may be helpful • If capable, instruct patients to huff or force cough with effort immediately prior to peak positive pressure assist. • If patient is not tolerant of initial settings, it may be helpful to start at higher frequency in vibration, keep cough assist short and work down frequency and bring up time while adding cycles gradually over time. • For patients dependent on continuous ventilation, consider shorter durations of vibration to cough or provide occasional mask ventilation • Device will go to Standby at end of timed treatment period; if ongoing support needed, reinitiate therapy. EXCLUSION CRITERIA • Burned skin or draining wounds under cuirass or seal area • Indwelling lines or tubes that are located under seal. (Within cuirass is acceptable) • Weight > 180 kg • Patient’s thoracic structure precludes establishment of good seal • Lack of viable airway either natural or artificial • Cardiopulmonary arrest

Copyright (c) 2020 United Hayek Industries (Manufacturing) Ltd. All rights reserved.