Beyond CPAP: The new oxygen delivery mask
Never before have we seen so much improvement in the basic delivery system of our most commonly given and clinically vital drug – oxygen
If you built a better mousetrap, would the world really beat a path to your door?
I recently asked myself this question in the context of the lowly oxygen mask. Sure, we now have CPAP, but many agencies frown on casual use of the expensive circuits. Today I would guess that every day most hypoxia patients are still treated with an Oxygen Non-Rebreather Mask. These simple disposable masks have changed very little.
For most of my early career, these things were made of vinyl. They smelled funny, and took on perplexing shapes when stored improperly. Today we have better materials, but the design of the mask is much the same.
It's completely flat. Lay one on a table and it looks like it was made for faces in a two-dimensional world. Unfortunately, my patients have all been pretty three dimensional. These masks fit most of them rather terribly.
Most of the oxygen is leaking around the seal of these masks like crazy. You can pinch the nose-bridge wire until it hurts and they will still leak. How can you tell? The bag reservoir does not empty with each inspiration.
The patient is pulling in atmosphere from leaks around the flat mask. I often wonder just how much oxygen they are really getting. Plus, think about how much we leak out of the ambulance as we roll down the road.
Enter the new Eco Oxygen Mask from Intersurgical. It's the first new thing in simple oxygen delivery masks in what seems like forever. It has a great form-fitting contoured mask seal. The self-sealing flange design provides a time-tested and proven airtight seal. I remember good resuscitation masks using similar designs very successfully.
Photo Dan White
The EquipLED's LED light source is the first on a reusable laryngoscope blade.
Instead of all your oxygen going out into the patient compartment, it goes into the patient. Now that's a great idea by itself. The added benefit is the improved respiratory monitoring. You can see the bag-reservoir cycling.
With each inspiration, the patient inhales the oxygen from the reservoir causing it to quickly collapse with each breath. This makes it virtually impossible to notice a change in respiration unless you left the patient in the back end by themselves.
We finally have a better mousetrap. The Eco Mask will likely deliver higher concentrations to patients who need oxygen desperately. While CPAP continues to be the definitive therapy for profound hypoxia, it makes me wonder about something.
I wonder if a big part of what makes CPAP so beneficial is delivering oxygen using a better mask that makes a better seal. Will the world beat a path to Intersurgical's door? I don't know yet, but I think if this mask gets ignored it will not be to anyone's benefit. For more information call 315-451-2900 or see this link.
Another new affordable product for EMS is the new EquipLED Laryngoscope Blades from Truphatek. On disclosure I work for Truphatek, and was an advocate for this blade design from the first moment I saw the original prototype. It's a two-piece design, like a finely crafted re-usable fiber optic blade. But instead of the separate pipe enclosing a light bundle, it protects the wire and LED.
The EquipLED is a standard conventional blade that fits on any standard handle. But its LED light source is the very first on a conventional and affordable, reusable laryngoscope blade.
Photo Dan White
EquipLED Laryngoscope Blade from Truphatek
The LED provides three times the light and ten times the battery life. There is no central shadow like with a conventional blade. In fact, there is no bulb to replace and the entire blade is guaranteed for two years, including the light.
When it finally wears out the replacement cost of $15 is far less than the bulbs alone would typically cost to replace in a conventional system.
Best of all, the LED generates no heat so it reduces risks to delicate tissues during sometimes difficult and prolonged EMS intubations.
With an LED you can better tune the light temperature, so the light is a brilliant white instead of yellow. It is the first really new thing in a basic re-usable laryngoscope that everyone can easily afford. People will actually save money while putting a lot more light on the subject of pre-hospital intubation. For more information contact Truphatek, Inc. on their website or call 573-657-0907.
In response to EMS1 member comments on this article, our columnist Dan White writes the following:
I mentioned CPAP only three times. I think all references were limited and valid questions to ask. One was, "I recently asked myself this question in the context of the lowly oxygen mask. Sure, we now have CPAP, but many agencies frown on casual use of the expensive circuits. Today I would guess that every day, most hypoxia patients are still treated with an Oxygen Non-Rebreather Mask. These simple disposable masks have changed very little." The other was "While CPAP continues to be the definitive therapy for profound hypoxia, it makes me wonder about something. I wonder if a big part of what makes CPAP so beneficial is delivering oxygen using a better mask that makes a better seal."
I did not write the somewhat inflammatory headline "Beyond CPAP …" which was added by the editor. I do, however, get to see all final drafts but being busy at the time, did not see the implications of the "jazzy" title. I did not stop to think how, with the other things mentioned in the article, the new title could lend a false impression, or suggest that the ECO Mask is better than CPAP.
As VentMedic says, "This mask is not a replacement for CPAP. CPAP and oxygen masks are two very different concepts for the delivery of oxygen, ventilation and oxygenation." He is absolutely correct, and as dpavlako mentions, "It is the positive pressure that is transmitted to the alveoli which increases the FRC, which in turn provides somewhat of an 'internal tourniquet,' so to speak. This increase in FRC is what allows for increased tissue oxygenation with a lower FiO2 — something that cannot be achieved by even the best designed non-rebreather masks, no matter how well fitted." He is also absolutely correct; true CPAP uses pressure and flow to enhance oxygen delivery and improve alveolar exchange.
I still think most CPAP masks are better than most disposable NRB Masks, particularly in the area of seal. I still think many thousands of patients hungry for oxygen are still treated each year with a NRBM. I still think many of those EMS services that do have CPAP use it either under limited protocol and/or also still use NRB Masks at 15-25LPM, right up until they fail, or when the patient drops below 90% SAO2 on so-called "100%," a fact I still dispute.
I completely agree that for those groups that have hypoxia, and have access to it, CPAP is a much better therapy than any disposable oxygen mask. I should have said so, and thanks for pointing it out. I was trying to review what I still think is the first new thing in an oxygen mask in forever. It does have a robust and innovative safety valve on the back side at the bottom of mask at reservoir junction, although it's not well pictured on the photos.
All clinical points by both commenters are well-taken and accepted as facts. Further, they are seen as advancements in dialog and help bring both depth and clarity to the article.
- Airway Management