Clinicians

What if you could ventilate…

ventilate-withoutmask
ventilate-nosedation
ventilate-nobarotrauma
ventilate-noinfection

And at the same time…

  • Increase cardiac output
  • Facilitate secretion clearance
  • Provide an active expiratory phase
  • Exercise musculature, promoting strengthening

 

 

Introducing Biphasic Cuirass Ventilation (BCV)

Overview

The United Hayek ventilators work using a unique Biphasic Cuirass Ventilation (BCV) technique. A negative pressure is generated within the chest cuirass, for inspiration or continuous inspiratory assistance, and applies a positive pressure within the cuirass inducing expiration. This positive expiratory pressure means that expiration is an active phase in the respiratory cycle this makes the Hayek RTX particularly efficient at CO2 clearance.
 

With over 300 publications to date, BCV is a very well proven method of ventilation.

 
BCV Provides an efficient and effective method of non-invasive external ventilation and is a real alternative to traditional forms of ventilation.

  • Mimics the natural physiology of spontaneous ventilation.
  • Active expiratory phase.
  • Full support with no risk with no risk of VAP, barotrauma or infection.
  • Eat, drink and talk while fully supported.
  • BCV can be used in place of BiPAP, CPAP (where underlying OSA if not a factor), vest and cough assist type devices, and in many cases, invasive positive pressure ventilation.

 

Simple Application

BCV works using a clear plastic shell called a Cuirass. The cuirass is lightweight and has a foam seal that maintain an airtight fit around the patient. It is very comfortable to wear. It is available in 12 different sizes, ranging from babies to adults.

Broad Applications

BCV can be used in both the hospital setting or at home. BCV is ideally suited for use in both acute and chronic, intubated or non-intubated patients.

Comfort Factor

BCV doesn’t just ventilate fantastically, it is really comfortable too. The seal is made of super soft foam, the cuirass is very light and it is designed to fit light a glove. United Hayek units automagically compensate for leaks, therefore the cuirass doesn’t need to be applied tightly.

Clean & Hygenic

The seal is hypoallergenic and it’s disposable too. This mean it’s hygenic, which helps to avoid infection, and, of course, it’s latex free.

Superb Technology

United Hayek units are really advanced. Devices like the Hayek RTX are crammed with the latest technology. It incorporates many modes of ventilation.

 

Biphasic Cuirass Ventilation

 

  • BCV offers complete non-invasive ventilation, high frequency chest wall oscillation, and assisted cough device.
  • BCV delivers all 4 modes of ventilation without changing the patient interface.
  • BCV can be used with positive pressure ventilation to improve clinical outcomes.
  • BCV is the only means of cardio-pulmonary support that functions in a truly physiologic way, increasing cardiac output.

 
clinicians-advantages
 

BCV has been successfully used on patients with:

  • Acute Respiratory Failure
  • Neuromuscular (E.g. SMA,Duchene’s etc)
  • Problems with Weaning from PPV
  • Cystic Fibrosis (CF) and those who require chest physiotherapy
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Head and Spinal Injuries
  • Ventilation during anesthesia in Ear Nose and Throat (ENT) Procedures
  • Aids Related Lung Disease
  • Ventilation Post-­‐Operation (E.g. post-­‐coronary bypass, Fontan, Fallot, post-­‐pneumonectomy)
  • Other patients problems that will potentially respond to BCV:
    • Need for ongoing recruitment of alveoli and small airways
    • Conditions requiring non-­‐invasive support for relief of increased WOB
    • Small airways disease
    • Need to improve oxygenation
    • Need to decrease RV workload and improve function
    • CO2 retention
    • Low or absent drive
    • Fatigued weak or poorly innervated pulmonary musculature
    • Anomalous cardiac flow situations
    • Restrictive processes
    • Obstructive processes
    • Mixed obstructive and restrictive
    • Muco-­‐proliferative lungs
    • Reoccurring atelectasis/pneumonias
    • Reoccurring pneumothoraces
    • Other means of support have not worked or is not desired i.e. BiPAP due to skin issues, or desire to avoid trach and PPV
  • Many more…

Case Studies


Chest X-ray films of an 88-year-old man with Adams-Stokes syndrome and pulmonary congestion. (Left) Extensive left-sided atelectasis. (Right) Atelectasis was resolved after treatment with the Hayek RTX.
 

Download Case Studies
 

Why BCV?

why-bcv
  • Non-Invasive
  • Complete Ventilation
  • Cost Effective
  • Physiological & Natural
  • Decreased Mortality
  • No Risk of VAP

BCV & Cardiac Benefits

  • Average > 60% increase in CO (Cardiac Output) has been documented with use in low CO states. Some individual studies > 100%
  • Improves venous return when used with PPV
  • Lower PA pressures and alveolar perfusion pressures
  • Can unload R heart
  • Improvement with acute cardiogenic pulmonary edema

BCV and Weaning

  • Decreased WOB allowed by BCV enhances weaning efforts, shortening time on vent and in ICU.
  • Application of BCV post-extubation decreases reintubation rate.
  • Often patients with even chronic vent needs will thrive without invasive interface ultimately using BCV

BCV Usage

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.

This mode of support can be easily adjusted/manipulated to suit the individual patients – requirements. 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 with decreased recession, use of expiratory muscles, metabolic acidosis, stable or falling CO2 and improved oxygenation.

The air within the cuirass can cause the infants to be at risk of temperature loss. It is advisable to dress them in pyjamas or warm clothes, without buttons as these can affect the seal on the cuirass. Or place them under a radiant heater

Once a suitable level of CNEP is found and the patient is n the recovery phase of their illness weaning from CNEP can be initiated by bringing down the level of CNEP and then once at an expectable level 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. References: 10, 11, 12, 13, 15.

Ventilation Modes

There are 3 different Ventilation modes available on the Hayek RTX.

There are 2 modes which are triggered by the patient’s respiratory effort, whare are “Respiratory Triggered” and “Respiratory Synchronized”. These modes can be used as pressure support modes and an aid to weaning.

Control Mode

This mode provides full control over the patient’s respiration

  1. Mandatory respiratory rate is set and delivered; patients do not fight against the mandatory breaths as the Hayek RTX uses their own respiratory muscles to breath. This is a unique function of the Hayek RTX as it mimics physiological respiration.
  2. Controls both inspiratory and expiratory phases and you have control over the I:E ratio
  3. Commence rate at 2 above their own current spontaneous rate, then can slowly decrease the rate as patients breathing controlled by Hayek RTX
  4. If PaCO2 increases alter I:E ratio to 1:1.2 – 1:1.5
  5. At frequency’ s over 60 the inspiratory pressure and the expiratory pressures should set at the same figures i.e. -15 and +15
  6. At frequencies of 240-1200cpm you can only preset frequency and inspiratory pressure parameters
  7. It is in this mode that you are able to oscillate the patient from 1-20Hz with pressures up to +/- 50 cmH2O

Respiratory Triggered

  1. Provides triggered ventilation with the respiratory cycle triggered by the patient’ s actual respiratory requirements
  2. The frequency is determined by either the patients rate or the minimum frequency set by the physician
  3. The I:E ratio is determined and set by the physician
  4. The trigger can either be through the cuirass or through the airway tube placed at or near the patients airway e.g. by the patients nose or mouth. Cuirass trigger will pick up more vigorous spontaneous breathing, whereas airway mode can be triggered by smaller, shallower respiratory effort.
  5. As the respiratory cycle is triggered by the patients own respiration, this allows better adjustment to the patients actual requirements. The respirator will wait for a period for the trigger; this is dependant on the trigger sensitivity set. If no trigger is detected during this period then the respirator will begin another cycle. In the event of apnoea the Hayek RTX will deliver the set back up rate.
  6. Trigger % should be 80-85% if higher you may need to adjust sensitivity, this is to ensure false triggers are prevented
  7. Minimum backup rate is 6 per minute i.e. 1 every 10 seconds
  8. Maximum backup rate is 60 per minute i.e.1 per second

Respiratory Synchronised

  1. This mode is fully synchronised with the patients own respiration, automatically adjusting the arte and shape of breathing in sympathy with the natural breathing adjustments being made by the patient themselves.
  2. 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.
  3. 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 physician
  4. The I:E ration will be calculated and displayed
  5. This mode will allow the patient to breathe both at their own rate and determine their own shape.
  6. In the event of apnoea the Hayek RTX will deliver the set back up rate delivering fully controlled ventilation at the pressures set



The cause of respiratory failure will determine the mode chosen and the settings programmed.

Normal lung:

Neuromuscular conditions, ventilation during anaesthesia, and ventilation post cardiac surgery (especially in Children), Head and Spinal Injuries references: 10, 11, 12, 13, 13,14, 15, 16, 17, 23, 24, 25, 26, 27, 28, 29, 35, 36, 52

Inspiratory: -21
Expiratory: +7
I:E Ratio: 1:1
Frequency: * see below
* When using synchronised mode set a minimum backup frequency at 10 less than the patient’s spontaneous breathing rate (lowest is 6cpm).

* When using control mode begin by setting frequency at 2-4 breaths above patient’s own spontaneous breathing rate.

Sick lung:

Restrictive

Bronchiolitis** Cardiogenic Pulmonary Oedema, Chronic Obstructive Pulmonary Disease (COPD), Emphysema, CF, references: 39, 45, 46, 49, 53, 54

Inspiratory: -18
Expiratory: +6
I:E Ratio: 1:1
Frequency : 60 cpm in control mode (can be increased up to 120 to improve results where necessary), 40 cpm backup in synchronised.

If necessary it is also possible to increase span and pressures keeping a pressure ratio 3:1

e.g. change -21 +7 or -24 +8

Obstructive

Asthma, bronchiolitis**, PCP, TB Pneumonia

Inspiratory: -24
Expiratory: +8
I:E Ratio: 1:1 or 1:2
Frequency: at spontaneous respiratory rate of patient in control mode, or respiratory rate of patient -10pcm as backup in synchronised mode

Low Compliance/Low Lung Volume

Respiratory Distress Syndrome references: 33, 38, 41, 44

Inspiratory: -30 Expiratory: +10 I:E Ratio: 2:1 Frequency: 40, 50, 60cpm up to 120cpm depending on patient

** The pathophysiology of bronchiolitis means that there are both restrictive and restrictive phases during the disease process.


It should be used when there is atelectasis, excess secretions or CO2 retention.
Divided into two parts

Vibration mode

This mode shakes and thins secretions
Insp/Expiratory: -8 +8
I:E Ratio: 1:1
Frequency: 800cpm *
Time 3-4minutes

* decrease the frequency for more tenacious secretions

Expiratory pressures in vibration mode are defaulted to the same as inspiratory pressures. Higher pressures are tolerated well e.g. +/- 15

Cough mode

This mode assists with expelling the secretions and can act as a mini sustained inflation.
Inspiratory: -25
Expiratory: +15
I:E Ratio: 4:1
Frequency: 50
Time: 3 minutes

The negative pressure can be made more negative as required.
Completion of both modes represents one cycle of secretion clearance mode

Each secretion clearance session should last between 30-60 minutes

It is possible to use higher pressures in cough mode e.g. -35 +25 as tolerated by the patient

It is helpful to introduce one or two cycles every few hours for most infants with bronchiolitis. The number and frequency of cycles can be adjusted according to the severity of the infant’s condition. Occasionally some infants cannot tolerate a full 3 minutes of cough when it is first introduced, in which case the mode setting can be changed earlier. They usually do get used to it fairly quickly.


According to the United States Census Bureau, approximately 320 million people reside in the United States of America and that number is on the rise.

Historical and recent possibilities of high profile pandemic outbreaks have raised awareness of the acute problem of treating and dealing with mass casualty situations. A pandemic is a disease outbreak, potentially reaching all areas of the world.

One particular issue of great concern is the lack of an adequate way to deal with large groups of people requiring ventilation quickly and effectively. The number of ventilators required to save the lives of people stricken with respiratory failure in a pandemic is far greater than the number of ventilators available.

Of the several major influenza pandemic outbreaks in the 20th century, the 1918 influenza was the most deadly. Killing roughly 50 million people worldwide, this 1918 outbreak eliminated a significant number of the world’s population.

During a severe influenza pandemic, many patients with respiratory failure who are able to receive mechanical ventilation may survive, while patients with respiratory failure who do not receive mechanical ventilation are likely to die.
The Center for Disease Control (CDC) assumes that ventilators will be in short supply in many communities prior to or during the peak of a severe influenza pandemic if something is not done.
According to the American Association for Respiratory Care, approximately 62,000 full-feature mechanical ventilators are available in the United States of America. This leaves more than 99% of the United States population without any available form of ventilation in the event of a pandemic outbreak. Current ventilator capacity and usage in the United States is about 75% to 95% utilized with existing cases (COPD, elderly, accident victims, trauma, post surgical, cardiac, etc)

Currently, Endotracheal (ET) intubation is utilized in conjunction with positive pressure ventilation for respiratory support in patients with cardiac or respiratory arrest during emergent situations.

Coupled with the shortage of qualified clinicians capable of managing endotracheal intubation, even with a stockpile of positive pressure ventilators, only a very limited number of patients can be treated.

Download Full Information Brochure


 

The Truth

Positive pressure ventilation techniques, as well as invasive mechanical ventilation, have a lengthy list of adverse effects, which BCV does not.

Some potential adverse physiologic effects of positive pressure ventilation (PPV) are:

  • Decreased cardiac output
  • Unintended respiratory alkalosis
  • Increased intracranial pressure
  • Gastric distension
  • Impairment of hepatic and renal function

Perhaps the most feared complications occurring during mechanical ventilation include:

  • Pneumothorax
  • Bronchopleural fistula
  • Development of nosocomial pneumonia

The use of positive pressure ventilation can lead to barotrauma, volutrama and possible development of a pneumothorax.

These complications can be entirely avoided with the use of BCV.

BCV: The Truth

BCV offers effective, even and natural ventilation without risk to the patient and can be applied by virtually anyone with minimal training.

BCV will also facilitate the clearance of secretions in contrasts to PPV, which compounds secretions.

BCV provides the only real solution to the complexities encountered in delivering life saving ventilation in such events.