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102. Noninvasive mechanical ventilation in acute and chronic

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102. Noninvasive mechanical ventilation in acute and chronic Powered By Docstoc
					        Thematic Poster Session                                                                                                       Hall B2-3 - 12:50-14:40
                                                            S UNDAY, S EPTEMBER 3 RD 2006

                                                                                    may be useful also in COPD patients with more severe acidosis and in non CODP
                                                                                    patients.


                                                                                    P1138
                                                                                    Is noninvasive ventilation underutilised in a Romanian respiratory intensive
                                                                                    care unit from a pneumology hospital?
                                                                                    Mirela Ciontu, Anca Macri, Genoveva Cadar, Radu Stoica. Respiratory Intensive
                                                                                    Care Unit, National Institute of Pneumology “M. Nasta”, Bucharest, Romania

                                                                                    Aim: To evaluate the indications and the level of utilisation of nonivasive ventila-
                                                                                    tion (NIV) in a Respiratory Intensive Care Unit (RICU).
                                                                                    Methods: In this retrospective study, 49 patients admitted in a 4 beds RICU in a
                                                                                    period of 1 year were included. The diagnosis, lenght of hospital stay in RICU,
                                                                                    in hospital mortality, relative frequencies of utilisation of invasive mechanical
                                                                                    ventilation (IMV) and NIV were noted, as well as the indications for NIV.
                                                                                    Results: Most frequent diagnosis was COPD-57.14% cases. Other diagnosis were:
                                                                                    10.20% asthma, 8.16% bronchiectasis and lung cancers respectively, 4.08% thyroid
                                                                                    cancers and ARDS respectively and1 case of cardiogenic pulmonary edema. Mean
                                                                                    duration of RICU stay was14.63 days. 59.18% of patients were intubated, the mean
                                                                                    duration of IMV being 9.72 days. 30.61% of patients died in hospital.55.10% of
                                                                                    all patients underwent NIV, only 14.28% being intubated after failure of NIV.The
                                                                                    most frequent indication for NIV was ACRF for acute exacerbation of severe
                                                                                    COPD-67.85% of COPD cases. Also, only 21.42% of these needed IMV. NIV was
                                                                                    also indicated in 80% of severe asthma cases and in 50% of lung cancer cases.
                                                                                    BiPAP was the most frequent mode used-42.85%.CPAP Helmet was applied in
                                                                                    66.66% of ARDS cases (all patients died intubated) and in other 2 cases: of asthma
                                                                                    and cardiogenic pulmonary edema respectively, with no intubation.
                                                                                    Conclusions: A good level of utilisation of NIV with a satisfactory intubation rate
                                                                                    as a measure of NIV failure was noted. There is a need for training of the staff
                                                                                    involved in the use of NIV, so that the spectrum of indications of NIV could be
                                                                                    broad and the results better.


                                                                                    P1139
                                                                                    Noninvasive ventilation in a high dependence unit – a real world experience
                                                                                    Carla A. Damas, Carla I. Andrade, Susana A. Ferreira, Jorge S. Almeida, José
                                                                                    P. Araujo, Paulo M. Bettencourt. Medicine Department, Hospital de São João,
                                                                                    Porto, Portugal

                                                                                    Background: The use of noninvasive positive pressure ventilation (NIPPV) in
                                                                                    patients with acute exacerbation of chronic respiratory failure (CRF) has become
                                                                                    usual in clinical practice.
                                                                                    Methods: Patients with acute exacerbation of CRF, non-responsive to medical
                                                                                    treatment were admitted in a high dependence unit, over a year. All patients had
                                                                                    an arterial blood pH<7,35 were considered to NIPPV.
                                                                                    Results: 78 patients were connected to NIPPV (57,7% male). The median age
                                                                                    was 71,9 yrs. Baseline pulmonary diseases were: chronic obstructive pulmonary
                                                                                    disease (80,8%), hypoventilation/obesity syndrome (23,1%), tuberculosis sequelae
                                                                                    (14,1%), sleep apnea (5,1%), and thoracic deformity (2,6%). Comorbidities were:
                                                                                    heart failure (42,3%), atrial fibrillation (26,9%) and diabetes mellitus (16,7%).
                                                                                    Home NIPPV was previously used in 4,6% of the patients, and long-term
                                                                                    oxygenotherapy in 47,7%. The cause of exacerbation was infection in 78,2%
                                                                                    of the patients (37,2% pneumonia). The median respiratory rate before the con-
                                                                                    nection to NIPPV was 26 cpm; the median arterial pH was 7,24; median PaO2 =
                                                                                    64,4 mmHg; and median PaCO2 = 87,7 mmHg. The median time of NIPPV was
                                                                                    132 hrs. NIPPV failed in 14,1% of the patients (death, need of invasive ventilation
 102. Noninvasive mechanical ventilation in                                         and non adaptation to NIPPV). In patients with pneumonia the NIPPV failed in
                                                                                    29,9%. The mortality rate was 9,5%.
   acute and chronic respiratory failure –                                          Conclusion: The use of NIVVP in patients with acute exacerbation of CRF had an
                                                                                    elevated rate of success, with mortality rates similar to those found in the literature.
               a broad field                                                         The unsuccessful rate in this study was inferior, when compared to other reports.
                                                                                    Our results provide evidence that NIVVP is effective in the real world.


P1137                                                                               P1140
Non invasive mechanical ventilation (NIV) in respiratory ward: effectiveness        Noninvasive mechanical ventilation (NIMV) in acute on chronic respiratory
in COPD and non COPD patients                                                       failure in an internal medicine ward. Determinants of nurse workload and
Soo-kyung Strambi, Daniele Giannini, Massimiliano Serradori,                        hospital length of stay
Nicolino Ambrosino. Cardiothoracic, Pulmonary Unit University-Hospital, Pisa,       Guido Vagheggini 1 , Ilenia Pisani 1 , Roberto Capiferri 2 , Alessandro Tafi 1 ,
Italy                                                                               Gabriella Sibilia 1 , Paola Galli 1 , Nicolino Ambrosino 3 . 1 Internal Medicine Unit,
                                                                                    S.M. Maddalena Hospital, Volterra, Pisa, Italy; 2 Ist Internal Medicine Unit,
Since May-2003 to end of 2005, 127 patients (age 72 ± 11 y), 62 f, underwent        Livorno General Hospital, Livorno, Italy; 3 Pulmonary Unit, Cardio-Thoracic
NIV in the respiratory ward for COPD exacerbation (65 patients: 42 with pH          Department, University Hospital, Pisa, Italy
7.30-7.35 and 23 with pH<7.30), and non-COPD (62 patients: lung cancer: (23),
neuromuscular disease (16), cardiac diseases (5), CAP (7 patients) and others       To evaluate nurse workload related to the ward-based NIMV we retrospectively
pathologies (8). NIV unsuccess was death or need of endotracheal intubation (EI).   analyzed 43 consecutive patients (23m:20f; age 75.3) with acute on chronic res-
NIV success was pH normalisation, absence of tachypnea or signs of respiratory      piratory failure (PaO2/FIO2: 2.08±.42; pH: 7.28±.08; PCO2 71.3±14.4) treated
muscle fatigue for 24 hours. NIV was unsuccessful in 13 out of 62 non COPD          with NIMV. APACHE II: 20.3±5.3; Dependence Nursing Score-DNS: 20.9±6.5,
patients (20,7%) (6 death, 7 EI) and in 9 out of 65 COPD patients (13,8%) (4        Therapeutic Intervention Scoring System-TISS: 20.7±5.5, Time Oriented Score
death, 5 EI). However COPD patients with pH< 7.30 at admission showed a higher      System-TOSS: 451±76 were evaluated during first 24h and compared with a
unsuccess rate than CODP patients with pH> 7.30 (30.4% vs 4.7% respectively).       control group of patients. Correlation between above variables and nurse activities
These results confirm that the use of NIV in the ward is an useful tool able to      and length of stay in hospital were evaluated. Thirty-seven patients (86%) were
reduce the mortality and need of EI, in COPD patients with pH> 7.30. Although       successfully treated; two patients (4.6%) deceased, 4 patients (9.3%) required
less effective than in COPD patients with mild acidosis, use of NIV in the ward,    invasive ventilation. Severity, dependency and workload scores in ventilated pa-


                                                                                187s

                                 Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
         Thematic Poster Session                                                                                                        Hall B2-3 - 12:50-14:40
                                                               S UNDAY, S EPTEMBER 3 RD 2006

tients resulted twice higher as controls. APACHE II, DNS, pH before and after            P1143
1 h of NIMV, age of patients and Charlson Index were correlated with TISS and            A prospective study for improvement of acute asthma by non-invasive
TOSS and, in patients successfully treated, with the length of stay in hospital.         positive pressure ventilation (NPPV)
Factor analysis defined three factors, which accounted for 76.8% of the variance:         Tomoyuki Soma 1,2 , Mitsunori Hino 1,2 , Kozui Kida 2 , Shoji Kudoh 2 . 1 Pulmonary
(1) severity at admission, (2) general health, (3) ventilatory impairment. Multiple      Center, Chiba-Hokuso Hospital, Nippon Medical School, Chiba, Japan;
                                                                                         2
regression: DNS explained the 69% of the TOSS variance of and 57% of the TISS              Department of Pulmonary Medicine, Infection and Oncology, Nippon Medical
variance; time of ventilatory support in the first 24 h explained 61% of the total        School, Tokyo, Japan
ventilation time variance. Hospital length of stay was affected by the duration
of the NIMV. Severity and dependency scores may predict acute phase nursing              Current guidelines for bronchial asthma recommend the initiation of therapy with
workload. The needs of NIMV in the first 24 h was related to the total hospital           aerosolized beta-agonists for patients with acute asthma. However, a substantial
length of stay.                                                                          number of patients do not show an adequate response. Non-invasive positive pres-
                                                                                         sure ventilation (NPPV) in addition to conventional treatment has been reported
                                                                                         to improve gas exchange in asthmatic patients with acute respiratory failure, lung
P1141                                                                                    function in mild to severe acute asthma. We hypothesized that NPPV would
Is there a learning curve in NIV for acute ventilatory failure-a two year                improve acute asthma attack without bronchodilator therapy. This study examined
experience?                                                                              patients with acute asthma randomized to receive either 8 cm H2 O of inspiratory
Darshan D. Pandit, Mike Doherty. Department of Respiratory Medicine, Russells            positive airway pressure or 6 cm H2 O of expiratory positive airway pressure
Hall Hopsital, Dudley, West Midlands, United Kingdom                                     delivered from a Bi-PAP® circuit for 60 minutes plus an intravenous infusion of
                                                                                         hydrocortisone (300 mg to 500 mg) as the NPPV group and patients receiving an
In this audit we set out to examine if increased experience with NIV had lead            intravenous infusion of hydrocortisone alone as control group. All patients were
to better outcomes. We compared two populations treated with NIV and also                carefully followed for 20 minutes. After the intervention ended, the control group
compared their outcome in terms of 30 day mortality. The first group consisted            received additional therapy. The following variables were measured: FEV1 , SpO2 ,
of patients treated in a 10 month period in 2000/2001 and the other group were           heart rate, respiratory rate, accessory-muscle use, wheezing, and Borg scale score.
all patients treated in 2003. Forty seven patients were treated in the earlier period    The median percent change in FEV1 from the baseline value significantly im-
and 85 in 2003. In terms of severity of disease, the two groups would seem to            proved after 40 minutes in the NPPV group compared with that in the control group
be similar, mean age 72(7) versus 69(12) years, (p>0.1), mean FEV1 was 40%               (+16.6% and -1.67%, respectively, p<0.0001). In addition, similar improvement
predicted in both groups, the proportion with a diagnosis of COPD as the cause of        in the Borg scale score and physical examination findings were observed. None of
their ventilatory failure being 38/47 versus 66/87 (p>0.2), proportion who were          the patients required re-hospitalization or return to the emergency room.
male was 24/47 versus 41/85 (p>0.2) and the proportion who deteriorated late into        These findings suggest that the NPPV without bronchodilators can improve acute
their admission (>24 hours) was 19/47 versus 38/85 (p>0.2). Most importantly             asthma attack.
the degree of acidosis, the most important prognostic indicator in exacerbations of
ventilatory failure, was similar in both groups, Ph 7.23 (0.09) versus 7.226 (0.09),
(p>0.2). The 30 day mortality in the earlier group was 14/47 versus 26/85 in the         P1144
2003 group, (p>0.2). As the two groups seem very similar in terms of severity of         Role of non invasive ventilation in ARDS patients
disease and mortality did not improve this would seem to suggest that there is no        Subodh Kumar Katiyar, Shailesh Bihari, Lalit Singh, Tara Rawat. Dept of TB &
learning curve in NIV.                                                                   Respiratory Dieases, Dr M.L. Chest Hospital, Kanpur, Uttar Pradesh, India
What did seem to change over the two year period is the number of patients treated,
47 in ten months versus 85 in a year. It might therefore be that rather than there       ARDS is traditionally managed with invasive mechanical ventilation but noninva-
really being no learning curve in NIV, that as NIV was made available to more            sive ventilation can be a better alternative in a selected group of them. Patients
and more patients, we selected poor prognostic patients in the later time period,        with clinico - radiological presentation of ARDS (Pao2/Fio2 < 200) were given
where this poor prognosis was not explained by any of the variables we measure.          bi-level positive pressure ventilation (NIPPV) via face mask, they were closely
                                                                                         monitored for signs of deterioration.Study end point was weaning from NIPPV
                                                                                         or requirement of invasive mechanical ventilation. Patients with haemo-dynamic
P1142                                                                                    instability, unconsciousness, copious secretions, arrhythmias, ph < 7.2 were ex-
Non invasive ventilation (NIV) usage in acute exacerbation COPD and its                  cluded from the study. Study included 12 cases, average age was 39 years (11-62).
impact on moods and quality of life (QoL)                                                Average Pao2/Fio2 at initiation of NIPPV was 153. 2/3 patients (66.66%) avoided
Syed A. Husain 1 , Ajay K. Kavidasan 1 , Sunny Sarfaraz 2 , Filomena Paciello 1 ,        mechanical ventilation & it was ultimately required in 4/12 patients (33.33%).
Rebecca L. Cannings-John 3 , Ann B. Millar 1 , Nabil A. Jarad 2 . 1 Respiratory          The reason were non-cooperation (2 cases), deterioration of Pao2/Fio2 (1 case) &
Medicine Department, Southmead Hospital, Bristol, Avon, United Kingdom;                  decrease in level of consciousness (1 case).The average duration of NIPPV in these
2
  Respiratory Medicine Department, Bristol Royal Infirmary, Bristol, Avon, United         4 patients before requirement of invasive ventilation was 11.75 hours (5-22).In
Kingdom; 3 Department of General Practice, Cardiff University, Cardiff, Wales,           the remaining 8 cases the average IPAP required was 16.8 cm of H2 O(10-18)
United Kingdom                                                                           and the average EPAP required was 8.2 cm of H2 O(6-10). The average duration
                                                                                         of treatment with NIPPV in the successfully treated patients was 7.2 days (5-9)
Introduction: Maintaining good Quality of life (QoL) is an important aspect of           & total duration of hospital stay was 11.4 days (8-17). There was no incidence
COPD management in a lot of elderly patients. We assessed moods and quality of           of VAP in patients treated with NIPPV. 2 out of 4 who required mechanical
life in context to Non invasive ventilation (NIV) usage.                                 ventilation died and one patient who was successfully treated with NIPPV died
Methods: Patients above 60 yrs with COPD exacerbations were included. Hospital           from an unrelated event (ventricular arrhythmia). This study suggests that NIPPV
Anxiety and Depression Scale (HADS) were used to measure depression and anxi-            as an alternative to selected patients of ARDS with close monitoring to invasive
ety at three time points. Quality of life (QoL) was assessed after discharge in stable   mechanical ventilation with a low rate of complications, decreased cost & duration
state using the Breathing Problem Questionnaire (BPQ) which usefully measures            of treatment.
QoL in elderly COPD patients. 33 item scores from 1 to 103, with higher score
predicting poor quality of life. Student’s independent t-tests were performed to
examine associations between Non invasive ventilation (NIV) usage and patient’s          P1145
QoL status and HADS scores.                                                              Effect of noninvasive ventilation (NIV) on left ventricular (LV) function,
Results: 79 COPD patients assessed; mean of 72 (range 60-93 years, sd=7.3).              B-type natriuretic peptide (BNP) and markers of systemic inflammation in
Eleven(14%) patients used NIV on admission. This sub-group of patients did not           patients with refractory heart failure
have differing anxiety or depression levels to ones not requiring NIV. However,          Sergey Avdeev, Xenia Popova, Galina Nekludova, Alexander Chuchalin.
they have a significantly higher BPQ score at stable state (NIV users: mean (sd)          Pulmonology Department, Research Institute of Pulmonology, Moscow, Russia
=60.8 (11.1), non-NIV users: mean (sd) =40.8 (25.5), t=-3.14, p=0.004), indicating
a poorer quality of life in NIV users.                                                   Rationale: Noninvasive respiratory support has an established role in the treatment
Conclusions:Elderly COPD patients requiring NIV have a poorer quality of life.           of patients with acute pulmonary oedema, congestive heart failure (CHF) with
However due to small numbers in the NIV group, these results should be inter-            central or obstructive apnea, but currently there is no data that NIV may help in
preted with caution and be further explored with larger trials. NIV remains an           the treatment of refractory CHF unresponsive to standard medical therapy.
important management strategy in severe COPD exacerbations but seems to reduce           Aim: To evaluate the effects of NIV on cardiac performance in patients refractory
the quality of life in the frail elderly patients who do not feel more depressed or      CHF.
anxious on this treatment compared to other COPD patients.                               Methods: 22 patients with refractory CHF were included into the study (14 males;
                                                                                         mean age 58±10 yrs, mean LV ejection fraction (EF) 29±6%). NIV was delivered
                                                                                         by nasal mask with BiPAP (16 pts) or CPAP (6 pts) modes. In all patients we
                                                                                         performed echocardiographic examination, measurement of serum BNP and serum
                                                                                         IL-6 at the beginning of NIV and after 14 days of NIV. The same measurement
                                                                                         were performed in patients of control group (11 pts, 8 males, age 61±10 yrs, mean
                                                                                         LVEF 28±6%).
                                                                                         Results: NIV treatment resulted into increase of LVEF (to 35±5%, p<0.001) and
                                                                                         decrease of LV end-diastolic volume (p<0.05). Significant positive improvements
                                                                                         were also found in Borg dyspnea scores, respiratory rate, pulse and vital capacity


                                                                                    188s

                                   Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
             Thematic Poster Session                                                                                                  Hall B2-3 - 12:50-14:40
                                                             S UNDAY, S EPTEMBER 3 RD 2006

(all p<0.01). In patients treated by NIV mean serum BNP levels decreased from         P1148
1036±492 to 452±307 pg/ml (p=0.015), and mean serum IL-6 levels decreased             Assessment of tuberculosis pleural effusions volume before and after
from 29.7±18.2 to 8.6±4.8 pg/ml (p=0.015). In control group on 14-th day there        treatment with noninvasive continuous positive airway pressure
were no changes in echocardiographic indices, BNP or IL-6 levels.                     Juliana F. Oliveira 2 , Fernanda C. Mello 2 , Ana Luiza Boechat 2 , Rosana
Conclusions: In patients with severe CHF NIV improves LV function, decreases          Souza Rodrigues 3 , Sara L. Menezes 1 . 1 College of Medicine - Physical Therapy
serum levels of BNP and IL-6 and may be considered as a useful adjunct in             School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; 2 College of
refractory CHF unresponsive to medical therapy.                                       Medicine - Post-Graduation Program, Federal University of Rio de Janeiro, Rio
                                                                                      de Janeiro, Brazil; 3 Clementino Fraga Filho University Hospital, Federal
                                                                                      University of Rio de Janeiro, Rio de Janeiro, Brazil
P1146
Evaluation of CO2 rebreathing associated to use of tubular spacers located            Tuberculosis (TB) is an infectious disease affecting nearly 32% of the world’s
between mask and expiratory valve in volumetric ventilators. A pilot study in         population with several cases of pleural disease. The usual treatment for pleural
healthy volunteers                                                                    tuberculosis (PTB) includes anti-TB drugs combined with physiotherapy, however
Daniel Samolski, Rosa Guell, Nuria Calaf, Pere Casan, Antoni Anton.                   there is not a consistent scientific report showing the physiotherapy’s role on
Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain          pleural effusion reabsorption. A controlled and randomized study was conducted
                                                                                      to evaluate PTB effusion volumes after treatment with noninvasive continuous
Introduction: the use of volumetric ventilators in non-invasive ventilation (NIV)     positive airway pressure (CPAP). Twenty patients with PTB effusions were re-
needs 2 main components: the mask and a circuit with its own expiratory valve.        cruited and allocated in two groups: 10 patients received physiotherapy with CPAP
The use of tubular spacers located between the mask and the expiratory valve is       (three times a week) combined with antiTB standard treatment and 10 patients
frequent, in order to obtain more comfort. These devices could increase the dead      received only the standard antiTB drugs. Computed tomographies using three-
space and interfere with ventilation’s efficacy while generating CO2 rebreathing.      dimensional image reconstruction were evaluated by blinded observer to estimate
To date, there is no one study that has evaluated this phenomenon.                    pleural effusion volumes at the beginning of treatment and after four weeks of
Objectives: to evaluate the presence of CO2 rebreathing with volumetric ventilators   interventions. The initial absolute median volumes were 430,09 ml and 495,29
of NIV while using these tubular spacers.                                             ml in the control and CPAP groups, respectively. The paired and unpaired t test
Method: 5 healthy volunteers were evaluated. We used a hermetic nasal mask            were applied to the same group and between groups, respectively, with statistical
(UltraMirageR , ResMed, Australia) and tubular spacers with an increasing volume      significance level established at p < 0,05. There was a significant decrement of
(43, 85 and 176 cm3 ) connected between mask and expiratory device. Using a           volumes in control (relative variation = 36,87 ± 1,74%, p = 0,006) and in CPAP
volumetric ventilator (Breas PV 501, Breas medical, Sweden), each volunteer           group (relative variation = 83,54 ± 1,91%, p < 0,001), but the CPAP group
performed a NIV period (tidal volume 8-10 ml/kg, respiratory rate 16-18 cpm, I/E      showed statistically significant bigger decrements than the control group (p <
relation 1/2). CO2 inspired fraction (FiCO2 ) was continuously analyzed using a       0,021). Noninvasive CPAP is an effective physiotherapeutic technique on PTB
probe located into the mask.                                                          resolution by accelerating the pleural effusion reabsorption.
Results: CO2 rebreathing was zero while using all the different volume spacers.
Fig. 1.
                                                                                      P1149
                                                                                      The effects of long-term nocturnal bi-level ventilatory support on gas
                                                                                      exchange in stable cystic fibrosis
                                                                                      Rajeev Soni 1 , Maree Milross 2 , Catherine Dobbin 2 , Iven H. Young 2 , Peter
                                                                                      T.P. Bye 2 . 1 Respiratory, Gosford Hospital, Gosford, NSW, Australia;
                                                                                      2
                                                                                        Respiratory, Royal Prince Alfred Hospital, Sydney, NSW, Australia

                                                                                      Nocturnal non-invasive bi-level ventilatory support (BVS), has been shown to
Conclusions: in healthy volunteers, the use of tubular spacers located between the    acutely reduce daytime PaCO2 in a proportion of subjects with cystic fibrosis
mask and the expiratory valve while using volumetric ventilators do not generate      (CF). There are no studies of the long-term effects of BVS on detailed ventilation-
CO2 rebreathing.                                                                      perfusion (VA /Q) inequality in CF, using the multiple inert gas elimination
                                                                                      technique (MIGET). It was aimed to determine the gas exchange mechanisms by
                                                                                      which nocturnal BVS effects daytime ABG.
P1147                                                                                 Stable subjects over 18 yrs age with CF, a FEV1 % predicted <65 and evidence
Performance of a novel humidification devcie for high flow oxygen therapy               for nocturnal desaturation were eligible for the study. The later was defined as a
Norman H. Tiffin 1 , Tuan Q. Tran 2 , Larry A. Weinstein 2 . 1 Research, Pari          total sleep time minimum average SP O2 ≤ 90%. BVS pressure titration during a
Respiratory Equipment, Midlothian, VA, United States; 2 Engineering, Pari             polysomnogram aimed to prevent oxy-haemoglobin desaturation and an elevation
Innovative Manufacturers, Midlothian, VA, United States                               in transcutaneous carbon dioxide. Spirometry, lung volumes, ABG and MIGET
                                                                                      measurements were made prior to and after the long-term use of BVS.
Rationale: To test the ability of a novel in-line humidification device (PARI          Five subjects used BVS for between 2.5 and 6 months. Baseline measurements
Hydrate, Pari Respiratory Equipment, Midlothian, VA) to heat and humidify dry         mean(SD) were: FEV1 % =29(11), PaO2 = 8.84(1.32) KPa, PaCO2 =6.65(0.43)
therapeutic gas at high flows. The new technology (C-Force; Pari Respiratory           KPa, log SDQ =0.88(0.36). There was little change in mean FEV1 % =1.5 or mean
Equipment) produces water vapor in a pressurized stream from an in-line, small        FVC% =0.3. One subject developed hyperinflation. There was a mean fall in PaO2
device placed proximal to the patient.                                                of 0.47 KPa (p = 0.24). There were significant mean falls in both PaCO2 by 0.55
Method: The Hydrate device was connected to a flowmeter by 1/8oxygen tubing            KPa (p =0.016) and in log SDQ by 0.34 (p =0.049). Four subjects had a marked
proximal to the device and large bore corrugated for outflow. Dry oxygen source        narrowing of their VA /Q distributions. One mechanism of improvement with BVS
gas was used at flows of 10, 20 and 40 L/min. Measurements of temperature and          could relate to the maintenance of small airway patency and mucociliary clearance
relative humidity (RH) were recorded from the device output. Source gas humidity      effecting small airway function.
was measured at less than 3% RH and temperature at 20o C. RH was measured             In conclusion, long-term BVS results in a significant improvement in daytime
using a hygrometer calibrated as per manufacturers instructions.                      PaCO2 , one of the mechanisms for this includes an improvement of daytime VA /Q
Results:                                                                              inequality.
Relative Humidity and Temperature of Gas Flow
                         RH (%)                 Temp (C)
source gas                 3.0                    20.0
10 L/min                  95.9                    35.9
20 L/min                  90.7                    36.6
40 L/min                  95.0                    36.0


Conclusions: This device is capable of heating and humidifying dry gas flows of
up to at least 40 L/min to over 35o C and over 90% relative humidity. Application
to high oxygen flow therapy is possible.




                                                                                  189s

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