The Boussignac Vygon CPAP _ Nebuliser by liuqingyan

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									 The Boussignac Vygon CPAP
        & Nebuliser
         In emergency situations,
The solution on how to treat acute Asthma




       David Greffe – CPAP & nebuliser – Seminar June.2005
                       Summary
• What is Asthma?
• Which treatment?
• Devices presently used
• What do we offer to practitionners and
  why?
• Procedure on how to use the Boussignac Vygon
  CPAP / nebuliser
• Target
• Market


          David Greffe – CPAP & nebuliser – Seminar June.2005
 What is Asthma?




David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration
              Respiratory tract




    David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration
                                      Trachea




   Now lets remove the pulmonary lobes


    David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration

                             Trachea            2 cm

                             Right & left
                                                1 cm
                             bronchi

                             Lobes Bronchi 0.5 cm = 5 mm

                             Bronchus
                                                0.25 cm = 2.5 mm
                             terminals

                             Bronchioli         0.12 cm = 1.2 mm




    David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration




    David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration
         Normal bronchus
             Alveoli




    Mucous               Lumen of
    membrane             bronchus




    David Greffe – CPAP & nebuliser – Seminar June.2005
    What is Asthma? illustration
                  Inflammed bronchus
             Contracted muscle
1

                                                               2
                                      Inflammed
                                      mucous
                                      membrane
                                  Swollen bronchus
                  Sécretion of
                  mucus
     3


         David Greffe – CPAP & nebuliser – Seminar June.2005
What is Asthma? illustration
                Normal bronchus




           Inflammed bronchus
                                                    It wheezes




    David Greffe – CPAP & nebuliser – Seminar June.2005
             What is Asthma?
• It is a severe respiratory insufficiency
• Due to an allergic reaction of the bronchus
• This respiratory insufficiency combines
  – a bronchospasm,
  – associated with inflammatory reactions (œdema)
  – And to a bronchus hypersecretion (increasing the
    obstruction)
• For summarizing, air cannot circulate because the
  patient airways have reduced a diameter and the
  asthmatic is suffocating


           David Greffe – CPAP & nebuliser – Seminar June.2005
              What is Asthma?
• How can the doctor diagnose an acute asthma crisis ?
  – The patient is anxious, aggressive, restless, cannot speak
  – UNUSUAL crisis for its intensity and its duration
  – Not improvement within 30 minutes
  – Cyanosis (the patient is becoming blue)
  – Perspirations
  – Respiratory frequency  30 cycles per minute
  – Cardiac frequency  120 heartbeats per minute
  – Peakflow measurement or Peak Expiratory Flow or PEF in
    order to know how severe the crisis actually is.


            David Greffe – CPAP & nebuliser – Seminar June.2005
             What is Asthma?
• The Peakflow or Peak Expiratory Flow or PEF, this
  is :




  The patient has to breath in the PEF which will
  measure the volume of air expired

           David Greffe – CPAP & nebuliser – Seminar June.2005
                 What is Asthma?
• The Peakflow or Peak Expiratory Flow or PEF
  indicates how severe the asthma crisis is:
• PEF values to keep in mind :
   – Normal for a man : 600 l/min
   – Normal for a woman : 450 l/min
• Values depending on severity               (in % of normal value):

 Acute asthma            Serious crisis              Light/moderate
                                                          crisis
PEF impossible      PEF = 30 to 50%                    PEF  50%
or  30%            (180 to 300 l/min)             ( 300 l/min)
( 180 l/min)


             David Greffe – CPAP & nebuliser – Seminar June.2005
Which treatment?




 David Greffe – CPAP & nebuliser – Seminar June.2005
           Which treatment?

• The treatment aims at opening rapidly
 the bronchi to facilitate the passage of
 air in and out of the lungs
• How ?
Using BRONCHODILATORS corticoids
 and mucolytics


          David Greffe – CPAP & nebuliser – Seminar June.2005
           Which treatment?

• The Bronchodilators or Beta 2 mimétics:
  – they will open bronchus (Trade names : Ventoline,
    Bricanyl, Atrovent, Pulmicort)

• The Corticoids:
  – They will decrease inflammation

• The Mucolitics:
  – They will fluidify the mucus



          David Greffe – CPAP & nebuliser – Seminar June.2005
           Which treatment?
                      Inflammed bronchus
                 Contracted muscle
    1
Broncho-
                                                              Corticoids
dilators
                                                                 2
                                          Inflammed
                                          mucous
                                          membrane
                                      Swollen bronchus
                      Sécretion of
                      mucus
        3
Mucolytics

             David Greffe – CPAP & nebuliser – Seminar June.2005
      Which treatment?


Bronchodilators are the drugs

primarily used and that is what

    we are going to focus


     David Greffe – CPAP & nebuliser – Seminar June.2005
  Currently used
    equipment



David Greffe – CPAP & nebuliser – Seminar June.2005
          AEROSOL equipment
      Currently usedTHERAPY
                     Aerosol Nebuliser
Single use
Mask




Single use
Nebuliser

Extention
tube

             David Greffe – CPAP & nebuliser – Seminar June.2005
   Currently used equipement
•Advantages of aerosol therapy
  •Easy to set up
  •Direct action on respiratory air ays
  •Very short duratio of on set (3 to 5 min)
  •Low quantities
  •Less side effects (tachycardia)
  •Simultaneous supply of O2
  •Humidification of airways (increases bronchus
  dilation)



          David Greffe – CPAP & nebuliser – Seminar June.2005
What do we propose to
 the practitionners?




  David Greffe – CPAP & nebuliser – Seminar June.2005
What do we propose to
   practitioners




  David Greffe – CPAP & nebuliser – Seminar June.2005
 What do we propose to
    practitioners

The whole assembly seems
    more complicated.
  Why do we propose it
          then ?


   David Greffe – CPAP & nebuliser – Seminar June.2005
     What do we propose to
        practitioners
   Current nebulisers                CPAP + Nebulisers
• Loss of medicine             • No loss of medicine (wall
  during expiration              image) - more drugs will
• Leak of device not             reach the patient’s lung
  airtight                     • CPAP ensures a forced
                                 inspiration
• The patient cannot
  inspire and                  • Airtight device
  therefore the                • Pressure opens bronchi
  medicine does not            • Smaller drugs particules
  penetrate                      which will reach more easily
  sufficiently                   the deep lung

         David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             •   A transparent O2 tube
                             •   A “T” piece
                             •   A nebuliser
                             •   A flowmeter
                             •   A mask
                             •   A fixation harness
                             •   A CPAP
                             •   A manometer
                             •   An attachement cord
                             •   A manometer extension
                                 tube

  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Connect the
                               transparent O2
                               Tube on oxygen
                               bottle




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Connect the
                               flowmeter on the
                               oxygen bottle




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Unscrew the
                               nebuliser
                             • Fill in drugs
                             • Screw the
                               nebuliser


                     As usual



  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Put the « T » piece
                               on the nebuliser




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Connect the CPAP
                               on the « T » piece




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Prepare the
                               manometer:
                             • Fix the
                               attachement cord
                             • Insert the
                               manometer
                               extension tube into
                               the manometer


  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Connect the
                               transparent oxygen
                               tube under the
                               nebuliser
                             • Connect the CPAP
                               green tube on the
                               flowmeter




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Choose the mask
                               and prepare it.




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Fix the mask on
                               the “T” piece and
                               connect the
                               manometer to the
                               CPAP




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Open the flow:
                                 – nebulisator to 6 l/Min
                                   (6 to 8 l/Min)
                                 – Check the production
                                   of a nebulisation fog




  David Greffe – CPAP & nebuliser – Seminar June.2005
Procedure on how to use
   CPAP / nebuliser
                             • Fix the mask on
                               the patient’s face
                               and set 3 cm H2O
                               pressure with the
                               flowmeter



  3 cm H2O


  David Greffe – CPAP & nebuliser – Seminar June.2005
Why the CPAP for Asthma ?




    David Greffe – CPAP & nebuliser – Seminar June.2005
  Why the CPAP for Asthma ?
                              Asthma

                           Suffocation                  AutoPEEP
Broncho-constriction


              The solution : CPAP + Nébulisation

Drugs fights          Pressure (2 to 4 removed or very
broncho-constriction cm H2O will allow    strongly
& the CPAP            to open bronchus decreased with
decreases the size of                     the CPAP
the particles of drug
(target deep lung)

            David Greffe – CPAP & nebuliser – Seminar June.2005
            Another indication

            Spastic APE
• It is an APE + a broncho spasm
• Today the doctor starts first
  nebulisation then CPAP
• Now he can do both together
• Nebuliser flow 6l/min CPAP 7.5 cm
  H2O as usual for APE



       David Greffe – CPAP & nebuliser – Seminar June.2005
CPAP and Nebulisation codes




    David Greffe – CPAP & nebuliser – Seminar June.2005
CPAP and Nebulisation codes

 • Nebuliser alone :
                          5569.01
 • Nebuliser + CPAP + Mask :
                         5571.XX3
 • Nebuliser+CPAP+ Mask+Fixation harness :
                         5572.XX3



        David Greffe – CPAP & nebuliser – Seminar June.2005
Answering questions from
     our customers




    David Greffe – CPAP & nebuliser – Seminar June.2005
Answering questions from our
        customers
• CPAP is not indicated for asthma and it
  can create a baro traumatism !
  – This is true, EXCEPT with our CPAP which is
    an open system.




        David Greffe – CPAP & nebuliser – Seminar June.2005
Answering questions from our
        customers
• The CPAP can create an alveolar hyper-
  distension !
  – No, because we are using a 2 to 4 cm H2O
    pressure level which allows to remove the
    auto-PEEP, to open bronchi and to nebulise
    the compatible particles of drugs deep down
    the lungs




        David Greffe – CPAP & nebuliser – Seminar June.2005
  Answering questions from our
          customers
• The CPAP, can create a bronchospasm
  because fresh and dry gas (oxygen) create
  a broncho spastic action
• This is true but oxygen is absolutely
  necessary to asthmatics during crisis and
  as nebulisation is in fluid form, gas is wet ;
  so no“bronchospasm” anymore.

          David Greffe – CPAP & nebuliser – Seminar June.2005
Answering questions from our
        customers
• Your product does not work !
  – You must tell to the doctor to put
   oxygen of the nebuliser first. THEN, the
   oxygen of the CPAP , thanks to the
    CPAP effect, the drug fog is less thick
   often not visible, particles are nearly one
   micron in size but the product works.


      David Greffe – CPAP & nebuliser – Seminar June.2005
         The market




David Greffe – CPAP & nebuliser – Seminar June.2005
                 The market
• 3.5 millions asthmatics in France

• 100.000 consultations for acute
 asthma (EMS & ER)

• 60% of the cases go to hospital

• 2000 patients die each year



       David Greffe – CPAP & nebuliser – Seminar June.2005
          The target




David Greffe – CPAP & nebuliser – Seminar June.2005
                     The target


              EMS & ER
And in priority those already equipped with our CPAP

 If you succeed to persuade our current customers

        then your sales will be multiplied by 3


          David Greffe – CPAP & nebuliser – Seminar June.2005
            Conclusion




David Greffe – CPAP & nebuliser – Seminar June.2005
                      Conclusion
• More and more studies recommend to couple
 CPAP and nebulisation for asthma
• The CPAP :
  – Opens bronchi
  – Decreases droplets diameter (therefore will reach
    more easily the deep lung )
  – Avoid the loss of medicine (+ 30 % of nebulised
    medicine)
  – Removal or decrease of auto PEEP


          David Greffe – CPAP & nebuliser – Seminar June.2005

								
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