You could ventilate a patient What if? Without the risk of barotrauma Without the risk of infections Without a facemask Without sedation You could ventilate a patient Increase cardiac output Facilitate secretion clearance Provide an active expiratory phase Exercise musculature, promoting strengthening And at the same time

Introducing Biphasic Cuirass Ventilation (BCV)

Introducing Biphasic Cuirass Ventilation (BCV)

BCV intro The Hayek RTX is a ventilator, high frequency chest wall oscillator, and assisted-cough device all in one. It allows us to deliver all three modes of ventilation without changing the patient interface. Can be used with positive pressure ventilation to improve clinical outcomes. The only means of cardio-pulmonary support that functions in a truly physiologic way, increasing cardiac output.

BCV Identification BCV Why? Who? Where? When?

Physiological and Natural Why? BCV Non-invasive Complete Ventilation Cost Effectiveness Physiological and Natural Decreased Mortality No risk of VAP

Why? Improvements in gas exchange Reduced work of breathing Actively controls both phases of the respiratory cycle. Provides even ventilation Maintain respiratory muscles Cardiac output improved Reduces end tidal PCO2 Why? Improvements in gas exchange Reduced work of breathing No risk of infections or barotraumas

BCV Who? Acute Respiratory Failure COPD and Asthma Neuromuscular (SMA, ALS, etc.) Head and Spinal injuries Cystic Fibrosis and those who require chest PT Problems with weaning from PPV And many more… Who?

Who? Acute Respiratory Failure COPD Reduced Mortality Reduced ICU admissions Reduced hospital length of stay Neuromuscular (SMA, ALS, CF, etc) Helps maintain the respiratory muscles Provides physiotherapy and cough assistance Provides an efficient method of weaning from PPV Acute Respiratory Failure No risk for VAP or barotraumas No requirement for sedation Facilitates the clearance of secretions

Where? BCV Emergency Room Hospital ICU/VRU Transportation Homecare

Where? Factors to Consider BCV can be applied successfully outside of the ICU/VRU setting. Outside of the ICU, cost efficiency is related to prevention of ICU admission. Staff training is achieved effectively in terms of ease of use. Allows for continuation of treatment for patients in the hospital, at home, in transport, and in emergency situations. BCV can begin to provide treatment for patients before their condition deteriorates and hospitalization is required. Is simple to use and comfortable for the patient.

When? Early Protocols Recognition Demand

Quick Comparison Alveolar Ventilation BCV Alveolar Ventilation Decrease in intrathoracic pressure Increase in Cardiac Output Increase in Venous Return Increase in renal function Increased FRC Positive Pressure Ventilation Airways through interface Increase in intrathoracic pressure Decrease in Cardiac Output Decrease in Venous Return Decrease in renal perfusion Follow the path of least resistance

Quick Comparison PATH OF LEAST RESISTANCE Positive Pressure Ventilation PATH OF LEAST RESISTANCE

Quick Comparison BAROTRAUMA Positive Pressure Ventilation PATH OF LEAST RESISTANCE BAROTRAUMA

Quick Comparison BCV

BCV Modalities BCV generates both inspiratory and expiratory pressures to produce 4 unique modalities of use, each with their own variation of benefits. The combination of the modalities is based on the needs of the patient

BCV Modalities CNEP Mode This mode of support uses CNEP which is applied to the thorax to expand lungs evenly for ventilation. This mode can be easily adjusted/manipulated to suit the individual patient’s requirements. The level is then adjusted until the work of breathing decreases. This will be noted with decreased retractions, use of expiratory muscles, metabolic acidosis, stable or falling CO2 and improved oxygenation. Used in conditions with increased work of breathing, small airways disease, V/Q mismatching and patients who may tire easily post extubation.

BCV Modalities Control Mode In control mode, positive and negative pressures are applied, along with a controlled I:E ratio, to actively control inhalation and exhalation. This allows for the provision of full ventilator support. A mandatory respiratory rate is set and delivered. The patients do not fight against the mandatory breaths, as BCV utilizes the patient's own thorax to effect respiration. This is a unique function which only BCV has; It mimics physiological respiration.

BCV Modalities Secretion Clearance (Vibration Mode + Cough Assist Mode) Vibration Mode (High Frequency Chest Wall Oscillation) Using frequencies of 240-1200 Cycles Per Minute, positive and negative pressures are applied to effectively expand and truly oscillate the chest wall and lungs to facilitate mobilization of secretions.

BCV Modalities Secretion Clearance (Vibration Mode + Cough Assist Mode) Vibration Mode (High Frequency Chest Wall Oscillation) Using frequencies of 240-1200 Cycles Per Minute, positive and negative pressures are applied to effectively expand and truly oscillate the chest wall and lungs to facilitate mobilization of secretions. Cough Assist Mode To finish the secretion clearance phase, a cough assist mode mimics a huff cough to force up secretions. Using an I:E Ratio with an extended inspiration and sharp expiration, BCV facilitates mobilization and removal of pulmonary secretions