First responder communication in CBRN environments: FIRCOM-CBRN study.

INTRODUCTION: Recent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment, they not only impair vision but also significantly reduce speech intelligibility. The recent introduction of electronic voice projection units (VPUs), attached to a respirator, may improve communication while wearing personal respiratory protection. OBJECTIVE: To determine the influence of currently used respirators and VPUs on medical communication and speech intelligibility. METHODS: 37 trauma anaesthetists carried out an evaluation exercise of six different respirators and VPUs including one control. Participants had to listen to audio clips of a variety of sentences dealing with scenarios of emergency triage and medical history taking. RESULTS: In the questionnaire, operators stated that speech intelligibility of the Avon C50 respirator scored the highest (mean 3.9, ±SD 1.0) and that the Respirex Powered Respiratory Protective Suit (PRPS) NHS-suit scored lowest (1.6, 0.9). Regarding loudness the C50 plus the Avon VPU scored highest (4.1, 0.7), followed by the Draeger FPS-7000-com-plus (3.4, 1.0) and the Respirex PRPS NHS-suit scored lowest (2.3, 0.8). CONCLUSIONS: We found that the Avon C50 is the preferred model among the tested respirators. In our model, electronic voice projection modules improved loudness but not speech intelligibility. The Respirex PRPS NHS-suit was rated significantly less favourably in respect of medical communication and speech intelligibility.

Chronic ventilator need in the community: a 2005 pediatric census of Massachusetts.

OBJECTIVES: The purpose of this study was to describe the population of children with chronic mechanical ventilation in Massachusetts and their patterns of medical care. PATIENTS AND METHODS: Investigators surveyed all of the Massachusetts home ventilator clinics, pediatric pulmonary services, hospital-based pediatric services for special health care needs, insurers, home care vendors, nursing agencies, the Massachusetts Department of Public Health, selected individual providers, and rehabilitation and long-term care facilities providing services to children with chronic respiratory support needs. Support was defined as daily use of noninvasive, negative-pressure, or invasive/transtracheal ventilators. Subsequent matching of demographic data, including date of birth, zip code, and gender supported maximal census yield without duplications. Geographic information systems were used to create distribution maps and estimate distances between children with chronic mechanical ventilator needs and key resources. RESULTS: A total of 197 children were identified as requiring chronic mechanical respiratory support in Massachusetts in 2005, which was a nearly threefold increase in this population in the 15-year interval since the last census. Congenital or perinatal-acquired neurologic or neuromuscular disorders constituted the majority of primary diagnoses (n = 107 [54%]). Chronic lung disease attributed to prematurity represented only 7% of the sample. CONCLUSIONS: Children receiving chronic mechanical respiratory support are a growing population. The shift in underlying diagnoses from pulmonary disease to neurogenic respiratory insufficiency has implications for hospital and community-based providers from all disciplines in extending services to the home setting. Barriers encountered when performing this study, however, reflect an overall lack of coordination among the many individuals and agencies involved in their care. Coordinated and centralized care efforts require a clear and managed flow of information; census reports such as this one are only the beginning. Direct needs assessments and quality-of-life surveys from families are needed to design and implement programmatic changes and advocacy efforts.

Understanding and implementing advances in ventilator capabilities.

PURPOSE OF REVIEW: To review the changes in mechanical ventilation technology over the past year and identify areas that provide a benefit. RECENT FINDINGS: The literature demonstrates a continued effort to improve patient ventilator synchrony though the development of new triggering and cycling methods. These techniques include using new signals and using closed loop techniques to respond to changes in patient breathing pattern. New modes of ventilation continue to be introduced, often without proof of efficacy. Fortunately, clinicians have developed alterations to new modes that improve utility and they continue to study these techniques clinically to determine appropriate use. Monitoring the patient remains an important area of investigation, with a flurry of activity surrounding pressure volume curves of the respiratory system. Finally, new ventilators have been introduced that combine high-end performance with small size and weight, while providing an on-board source of air. SUMMARY: Mechanical ventilation is ubiquitous to intensive care. Advances in ventilator technology are rapid, and clinicians must keep abreast of changes in ventilator performance and application.

Patient ventilation and oxygenation. A new day is dawning.

Maintaining an airway and providing adequate ventilation and oxygenation to the patient can be challenging in the prehospital environment. Ventilation and oxygenation are a complex series of interactions between the patient, EMS providers and emergency airway equipment. Routine ventilation techniques carry significant risk of long-term complications. New ventilatory equipment is available to perform this function and provide verification of its effectiveness. This opportunity for improved patient care is available to all EMS providers and sets new standards for delivery of ventilation and oxygenation. The technical methods available to EMS personnel vary considerably and are reviewed in this article.

Mechanical ventilation innovations: the manufacturer's perspective.

Manufacturers develop products that fit the corporate vision and maximize their return on investment. The expense and time required by the FDA regulatory approval process have a negative impact on product innovation. I propose the following approach: Reduce the amount of documentation required for a PMA or 510(k). Reduce approval times through cooperative interaction among manufacturers, clinicians, and the FDA throughout the product-development process. Allow independent agencies to provide product approvals. Efficacy assessment guidelines should be a function of the level of risk and the claims made for the marked device.

Introducing new mechanical ventilation technology: the hospital perspective.

The introduction of innovative mechanical ventilation technology requires a careful assessment of the cost-benefit relationship of the new technology. Justification for purchase can be sometimes be made on the basis of improved patient safety and physiologic response. Improved patient outcome is much more difficult to demonstrate. It is clear in today's health-care environment that outcome-based research is needed before new technology is introduced to the marketplace, if that new technology is to become part of the average community-hospital complement of mechanical ventilators.

The iron lung: halfway technology or necessary step?

The iron lung is often used to epitomize the costly halfway technologies of modern-day medicine that fail to cure and only prolong a seriously compromised existence. Historical evidence indicates that the iron lung was not a costly instrument of last resort; instead, it was a lifesaving device that played a critical role in the evolution of modern respirators and respiratory care. Contrary to the prevailing views of the biomedical research community, the creation of new devices and instruments is often as important a source of technical change in medicine as are advances in the biological sciences.