A gas-powered, patient-responsive automatic resuscitator for use in acute respiratory failure: A bench and experimental study

Annemijn H. Jonkman, Bhushan H. Katira, Annia Schreiber, Cong Lu, Doreen Engelberts, Fernando Vieira, Alexandra Marquez, Arthur S. Slutsky, Paul Dorian, Laurent J. Brochard

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

BACKGROUND: During the COVID-19 pandemic, a need for innovative, inexpensive, and simple ventilator devices for mass use has emerged. The Oxylator (CPR Medical Devices, Markham, Ontario, Canada) is an FDA-approved, fist-size, portable ventilation device developed for out-of-hospital emergency ventilation. It has not been tested in conditions of severe lung injury or with added PEEP. We aimed to assess the performance and reliability of the device in simulated and experimental conditions of severe lung injury, and to derive monitoring methods to allow the delivery of safe, individualized ventilation during situations of surge. METHODS: We bench-tested the functioning of the device with an added PEEP valve extensively, mimicking adult patients with various respiratory mechanics during controlled ventilation, spontaneous breathing, and prolonged unstable conditions where mechanics or breathing effort was changed at every breath. The device was further tested on a porcine model (4 animals) after inducing lung injury, and these results were compared with conventional ventilation modes. RESULTS: The device was stable and predictable, delivering a constant flow (30 L/min) and cycling automatically at the inspiratory pressure set (minimum of 20 cm H2O) above auto-PEEP. Changes in respiratory mechanics manifested as changes in respiratory timing, allowing prediction of tidal volumes from breathing frequency. Simulating lung injury resulted in relatively low tidal volumes (330 mL with compliance of 20 mL/cm H2O). In the porcine model, arterial oxygenation, CO2, and pH were comparable to conventional modes of ventilation. CONCLUSIONS: The Oxylator is a simple device that delivered stable ventilation with tidal volumes within a clinically acceptable range in bench and porcine lung models with low compliance. External monitoring of respiratory timing is advisable, allowing tidal volume estimation and recognition of changes in respiratory mechanics. The device can be an efficient, low-cost, and practical rescue solution for providing short-term ventilatory support as a temporary bridge, but it requires a caregiver at the bedside.

Original languageEnglish (US)
Pages (from-to)366-377
Number of pages12
JournalRespiratory care
Volume66
Issue number3
DOIs
StatePublished - Aug 18 2020
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported in part by Toronto COVID-19 Action Fund from the University of Toronto and CIHR (FDN143285 and OV3-170344). The Oxylator devices were provided free of charge by CPR Medical Devices; the company played no role in the design and conduct of the study.

Publisher Copyright:
© 2021 Daedalus Enterprises.

Keywords

  • Acute respiratory failure
  • COVID-19
  • Mechanical ventilation
  • Pandemic
  • Rescue ventilation

PubMed: MeSH publication types

  • Journal Article

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