Biphasic Cuirass Ventilation (BCV)

1. Biphasic Cuirass Ventilation (BCV) The United Hayek Hayek RTX

2. Conventional mechanical ventilation • In positive pressure ventilation (PPV), the gas pushed into the lungs naturally follows the path of least resistance, therefore ventilating the already well ventilated areas. • Increases in pressures/volumes to aid ventilation of all areas of the lungs leads to barotrauma, volutrauma and possible development of a pnuemothorax. • These complications, along with those of ventilator associated pneumonia, are of no relevance with biphasic cuirass ventilation (BCV).

3. How the Cuirass (BCV) is different • The pressure applied within the cuirass acts uniformly over the thorax, thus lung expansion is also uniform, ventilating all areas of the lungs. • A negative pressure is generated within the chest cuirass for inspiration or continuous inspiratory assistance • A positive pressure within the cuirass induces expiration, making the Hayek RTX particularly efficient at CO2 clearance • BCV in conjunction with PPV is used as an aid to weaning, to increase right ventricular function and to aid in expansion of areas of collapse • No risk of VAP, barotrauma or infection. • No additional sedation required. • Allows patients to eat, drink and talk while fully supported unlike any other form of invasive or non-invasive ventilation.

4. Who would benefit from BCV? Patients with any of the following: • Acute Respiratory Failure • Chronic Obstructive Pulmonary Disease (COPD) • Neuromuscular (e.g. SMA, Duchennes, etc.) • Head and Spinal Injuries • Problems with Weaning from PPV • Ventilation during anesthesia in Ear Nose and Throat (ENT) Procedures • Cystic Fibrosis (CF), and those who require physiotherapy • Aids Related Lung Disease • Asthma • Ventilation post-operation (i.e., post-coronary bypass, Fontan/Glenn, post-pneumonectomy)

5. Modes of ventilation with BCV Continuous negative pressure (CNEP)Used in conditions with increased work of breathing, small airways disease, V/Q mismatching and those infants who may tire easily post extubation. • Start your CNEP roughly 2cms H2O more than you would CPAP. This level is then adjusted until the increase work of breathing decreases. • This will be noted clinically with decreased retractions, decreased use of expiratory muscles, resolving metabolic acidosis, stable or falling CO2 and improved oxygenation. • Weaning from CNEP can be initiated by bringing down the level of CNEP, then taking the patient off for controlled periods. These are gradual lengthened to suit the patient. • CNEP helps improve right ventricular function, especially when used in conjunction to PPV. • This mode of support can be easily adjusted/manipulated to suit the individual patients

6. Modes of ventilation with BCV (cont.) Control ModeThis mode provides full control over the patient' s respiration • Mandatory respiratory rate is set and delivered; patient’s own respiratory muscles are used to breath. This is a unique function of the Hayek RTX as it mimics physiological respiration. • Controls both inspiratory and expiratory phases by setting the I:E ratio • Commence rate at 2 above their own current spontaneous rate, then can slowly decrease the rate as patients breathing controlled by Hayek RTX

7. Modes of ventilation with BCV (cont.) Respiratory synchronized This mode is fully synchronized with the patients own respiration, automatically adjusting with the natural breathing adjustments being made by the patient themselves. • The patient' s inspiratory effort creates an initial trigger which is followed by a further trigger by the initial effort of expiration. The trigger can be either through the cuirass or airway. • Difference between this mode at respiratory triggered is that on this mode the support is timed with patients own respiratory pattern, so no I:E ratio is set by the provider • The I:E ration will be calculated and displayed • This mode will allow the patient to breathe both at their own rate and determine their own pattern. • In the event of apnea the Hayek RTX will deliver the set back up rate delivering fully controlled ventilation at the pressures set

8. Modes of ventilation with BCV (cont.) Secretion Clearance should be used when there is atelectasis, excess secretions or CO2 retention. It is divided into two parts: Vibration mode • This mode shakes and thins secretions • Similar effect as IPV treatments Cough mode • This mode assists with expelling the secretions • Can act as a mini sustained inflation (similar to HIT) • The negative pressure can be made more negative as required. Completion of both modes represents one cycle of secretion clearance mode.

9. Hayek RTX Respirator cuirass

10. Nursing Considerations • The air within the cuirass can cause the patient (especially infants) to be at risk of temperature loss. Dress patients in pajamas or warm clothes (without buttons as these can affect the seal on the cuirass), or place them under a radiant heater or bair hugger • Lines on the patient’s chest (chest tubes, CVL, g-tube, etc.) will need to have skin protection such as duoderm where they exit the seal • EKG leads should be placed on the patient’s limbs or back outside of the chest cuirass • Skin must be carefully inspected around the chest cuirass seal to look for redness or breakdown

11. Nursing Considerations (cont.) • Each time the cuirass is removed and reapplied, always start in continuous negative pressure (CNEP).  That is the only way to get a seal before you connect the straps to the shell.Even if you are using another mode, you must start with CNEP. • Apply the cuirass shell using a rocking motion, either top to bottom or side to side. Avoid pushing the cuirass straight down on the patient as this can damage the foam and cause skin breakdown. • Oxygen must be provided via another source, and the patient must be able to maintain a patent upper airway • Charting modes and settings will be via “sticky note” until built into HED