Addition of bacterial filter alters positive airway pressure and non-invasive ventilation performances

Rabec, Claudio; Fresnel, Emeline; Retory, Yann; Zhu, Kaixian; Joly, Karima; Kerfourn, Adrien; Dudoignon, Benjamin; Mendoza, Alexis; Cuvelier, A.; Muir, Jean-François; Melloni, B.; Chabot, J; Gonzalez-Bermejo, Jésus; Patout, Maxime

doi:10.1183/13993003.02636-2021

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…Three reports elaborated on the health risks of recalled PAP devices, such as cancer (Kendzerska et al, 2021;Palm et al, 2022;Wang and Xiao, 2022). One report examined whether recalled PAP devices could be modified to reduce risks (Rabec et al, 2022). In our domain of organizational case studies, we found two accounts, one from Mayo Clinic (Morgenthaler et al, 2022) and one from the Cleveland Clinic (Lance et al, 2022).…”

Section: Introduction Nature Of Problem Being Addressedmentioning

confidence: 95%

Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study

et al. 2023

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This case study describes, for the time frame of June 2021 through August 2022, the U.S. Veterans Health Administration (VHA) organizational response to a manufacturer's recall of positive airway pressure devices used in the treatment of sleep disordered breathing. VHA estimated it could take over a year for Veterans to receive replacement devices. Veterans awaiting a replacement faced a dilemma. They could continue using the recalled devices and bear the product safety risks that led to the recall, or they could stop using them and bear the risks of untreated sleep disordered breathing. Using a program monitoring approach, we report on the processes VHA put in place to respond to the recall. Specifically, we report on the strategic, service, and operational plans associated with VHA's response to the recall for Veterans needing replacement devices. In program monitoring, the strategic plan reflects the internal process objectives for the program. The service plan articulates how the delivery of services will intersect the customer journey. The operational plan describes how the program's resources and actions must support the service delivery plan. VHA's strategic plan featured a clinician-led, as opposed to primarily legal or administrative response to the recall. The recall response team also engaged with VHA's medical ethics service to articulate an ethical framework guiding the allocation of replacement devices under conditions of scarcity. This framework proposed allocating scarce devices to Veterans according to their clinical need. The service plan invited Veterans to schedule visits with sleep providers who could assess their clinical need and counsel them accordingly. The operational plan distributed devices according to clinical need as they became available. Monitoring our program processes in real time helped VHA launch and adapt its response to a recall affecting more than 700,000 Veterans.

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Section: Introduction Nature Of Problem Being Addressedmentioning

confidence: 95%

Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study

et al. 2023

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“…Therefore, the interposition of viral–bacterial filters in the inspiratory limb was recommended. However, a bench study showed that the addition of such filters had adverse effects on ventilator performance, with an increase in the product pressure time required to activate the trigger (PTPtrig), lower pressurisation and lower tidal volume [ 29 ]…”

Section: Filters and Other Itemsmentioning

confidence: 99%

What Circuits, Masks and Filters Should Be Used in Home Non-Invasive Mechanical Ventilation

Luján

Flórez²,

Pomares³

2023

JCM

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Most of the published reviews about non-invasive home ventilation mainly reflect the technical aspects of ventilators. There is much less information about the consumables most used at home. However, the choice of a good interface or tubing system can lead to physiological changes in the patient–ventilator interaction that the clinician should be aware of. These physiological changes may affect the performance of the ventilator itself, the reliability of monitoring and, of course, the comfort of the patient. The use of different circuits, masks or filters is therefore related to the concepts of rebreathing, compressible volume, instrumental dead space or leak estimation and tidal volume. Through certain bench experiments, it is possible to determine the implications that each of these elements may have in clinical practice.

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“…

We read the innovative study by RABEC et al [1] with great interest, in which they evaluated the impact of use of different inline bacterial filters on the performance of non-invasive ventilator (NIV) using positive inspiratory pressure (PIP) ventilation. After analysing the study, we want to raise some points which are vital in interpreting the outcomes of this study.While inline placement of bacterial filter will obviously protect against inhalation of any broken parts of the NIV machine, they are known to affect the overall performance of the NIV.

…”

mentioning

confidence: 99%

“…We read the innovative study by RABEC et al [1] with great interest, in which they evaluated the impact of use of different inline bacterial filters on the performance of non-invasive ventilator (NIV) using positive inspiratory pressure (PIP) ventilation. After analysing the study, we want to raise some points which are vital in interpreting the outcomes of this study.…”

mentioning

confidence: 99%

Balancing the risks and benefits is essential for reaping the success of adding in-circuit bacterial filters

et al. 2022

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We read the innovative study by RABEC et al. [1] with great interest, in which they evaluated the impact of use of different inline bacterial filters on the performance of non-invasive ventilator (NIV) using positive inspiratory pressure (PIP) ventilation. After analysing the study, we want to raise some points which are vital in interpreting the outcomes of this study.While inline placement of bacterial filter will obviously protect against inhalation of any broken parts of the NIV machine, they are known to affect the overall performance of the NIV. They are well-known to cause reduction of delivered tidal volumes, rise in PIP, and delay in the inspiratory trigger which will obviously necessitate higher trigger and PIP setting to overcome this extra load [2,3].Along with the measured interferences of these bacterial filters that are assessed in this study, some data on the additional dead space, airflow resistance, and loss of any delivered tidal volume through air leak imposed by these filters will allow us to understand the consequence of their overall impact on the performance of the NIV. Also, the measured tidal volumes here differed widely, from 568-946 mL among the groups, which look well above the recommended limits of lung protective ventilation. Presumably a higher gas flow was possibly used to generate these extra volumes which is known to cause higher resistance to expiration and can lead to intolerance as well as ventilation asynchrony [4]. This aspect was neither thought of, nor was analysed in this study. It is interesting to note that the NIV asynchrony index was not affected in this study. Possibly the simulated design of this study failed to show this side which is known to happen in the real-life scenario. As most sick patients with acute respiratory failure prefer to remain in recumbent position, which results in collapse of airways in the lesser ventilated areas, a much higher PIP will be required primarily to overcome this where trigger sensitivity becomes secondary [5]. Also, it is not clear from the study what type of NIV circuit (double or single) and interface were used. Performance of NIV (inspiratory flow and trigger, trigger delay, generation of maximum PIP, delivered tidal volume), work of breathing and inspiratory pressure time product are well-known to be affected by the choice and types of these two important equipment as well [5]. Thus, knowing the exact types of those used here will be vital to assess the actual contribution of the inline bacterial filter on the overall performance of the NIV.We applaud the innovative approach by the authors to find the most suitable inline bacterial filter to be preferred during NIV, which is now a recommended practice, but to interpret the final impact of this we need further clarifications on the above-mentioned dilemmas.

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Addition of bacterial filter alters positive airway pressure and non-invasive ventilation performances

Cited by 3 publications

References 10 publications

Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study

Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study

What Circuits, Masks and Filters Should Be Used in Home Non-Invasive Mechanical Ventilation

Balancing the risks and benefits is essential for reaping the success of adding in-circuit bacterial filters

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