1)Toyooka Hospital, Hyogo, Japan 2) OKADA Kodomonomori Clinic, Saitama, Japan United Hayek power unit. Introduction

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1 K59 Investigation of the efficacy of biphasic cuirass ventilation for children hospitalized with a moderate bronchial asthma Toshinori Minato 1), Kuniyuki Okada 2) 1)Toyooka Hospital, Hyogo, Japan 2) OKADA Kodomonomori Clinic, Saitama, Japan United Hayek power unit Introduction Biphasic cuirass ventilation (BCV) is an external ventilator with five respiratory modes. Pressure sensor We have observed that the combination of the continuous Cuirass Wide pore tube negative mode and the secretion clearance mode can deliver rapid and effective relief for moderate exacerbations of bronchial asthma (BA), characterized by limited airflow due Hayek RTX to bronchoconstriction, airway edema, and mucus plug formation. Therefore, we investigated the efficacy of BCV for moderate BA attacks. How to move BCV? 1 Cuirass is placed on the patient. 2 Cuirass is connected to a United Hayek power unit (Hayek RTX or Hayek HRTX). Spread Set & Bind Connect to Power Unit Mechanism of BCV Inspiratio Expiration diaphrag diaphrag 1

2 Five respiratory modes 1 Continuous negative pressure This mode applies only a negative pressure within the cuirass, which is a plastic shell over the thorax. The patient can breathe easily because their lung was expanded. 2 Secretion clearance This mode applies a negative and a positive pressure within the cuirass alternately to vibrate the patient s chest wall. This mode can asist secretions like a physical therapy. 3 Control mode 4 Respiratory triggered 5 Respiratory synchronized The effect of BCV Improve oxygenation Simple and easy to set on or off, Maintain the quality of life(eat, feed, speak), In positive pressure ventilation s complications (ex. barotrauma, volutrauma, pnuemothorax and ventilator associated pneumonia) are of no relevance with BCV. Fault Skin damage arises due to an excess of pressure. Air leakage (it does not fit) makes temperature decrease. It is necessary for small children not to remove cuirass. 2

3 The purpose of this study What kind of effect dose BCV bring child s asthmatic attack therapy? Method BCV was introduced to our hospital in Dec 2012 and we performed additional BCV therapy in the cases which did not react to BA primary care, and admitted. We performed a retrospective study to analyze the clinical data of 14 children with moderate BA attacks admitted to our Hospital between Jan 2014 and Oct 2015 (Group A: Conventional therapy add on BCV). The results of these patients were compared to those of a control group consisting of 15 patients hospitalized for moderate BA attacks before the hospital had introduced the use of BCV (Group B: Conventional therapy). 3

4 1 Result Changes in Heart Rate(HR), Respiratory Rate(RR) and Oxygen saturation(spo2) in the group A and B Significant improvements in HR and RR were obtained in both the A and B groups. 1 Comparison of the difference of change of HR, RR and, SpO2 in the group A and B The level of improvement in HR and RR in the group A was found to be significantly better in the Group B. 2 Comparison of BA therapy in the group A and B Duration of oxygen therapy was significantly shorter in the Group A. There was no significant intergroup difference in the steroid administration period and the number of cases of continuous isoproterenol inhalation. 4 Comparison of the length of hospitalization, and the number of IPPV required and adverse events in the group A and B Length of hospital stay was significantly shorter in the Group A 4

5 Discussion (BCV) Continuous Negative Mode (BCV) Secretion Clearance Mode Conclusion BCV is an effective method for children with moderate bronchial asthma attacks. BCV is considered to be useful from a health economic perspective, since duration of oxygen use and hospitalization become shorter. Reference 1) Okada K, Ueda Y. Biphasic cuirass ventilation Japanese Society of Respiratory Care Medicine.2010; 27: Application for children 2) Linton DM. Cuirass Ventilation: A Review and Update. Crit Care and Resusc. 2005; 7:22-8. Many of the actual and potential beneficial applications including in emergency situations of BCV 3) Klonin H, Bowman B, Peters M, et al. Negative pressure ventilation via chest cuirass to decrease ventilator-associated complications in infants with acute respiratory failure: a case series. Respiratory Care. 2000; 45: Chest cuirass Negative Pressure Ventilation may provide a partial solution that avoids many of the pitfalls of previous ventilation strategies. 4) Deep A, De Munter C, Desai A. Negative pressure ventilation in pediatric critical care setting. Indian J Pediatr. 2007;74: Clinical applications of negative pressure ventilation together with associated risks and limitations. 5) Francesco, G., Doreen, E., Emma, H. et al: Negative-Pressure Ventilation. Am 5

6 J Respir Crit Care Med. 2008; 177: Better Oxygenation and Less Lung Injury 6) Massimo, B., Annalisa, B., Thomas D. et al: Effects of continuous negative extrathoracic pressure versus positive end-expiratory pressure in acute lung injury patients. Crit Care Med. 1998; 28: In acute lung injury patients, a continuous negative extrathoracic pressure (CNEP) of -20cmH2O has capability to obtain transpulumonary pressure and lung function improvement similar to a PEEP of 15 cmh2o. 7) Mundie TG, Finn K, et al. Continuous Negative Extrathoracic pressure and positive end-expiratory pressure. Chest 1995; 107: By properly referencing pressures, CNEP or PEEP in tandem with IMV results in equivalent effects on pulmonary function (PaO2, End-expiratory lung volume)and hemodynamics in piglets with pulmonary hypertension secondary to E.coli endotoxin infusion. Case report 1) Tonan M, Hashimoto S, Kimura A, et.al. Successful treatment of severe asthmaassociated plastic bronchitis with extracorporeal membrane oxygenation. J Anesth 2012;26: ) Uno H, Ohkuma C, Fujiwara M, et al. A case of a severely multiple handicapped man with respiratory failure which was improved by Biphasic Cuirass Ventilation. Japanese Journal of Pediatrics 2014;67: ) Yamaoka A, Miura K, Abukawa D. A case of severe pneumonia caused by pandemic 2009 influenza A(H1N1) which was improved by a Biphasic Cuirass Ventilation (BCV). Journal of Pediatric Infectious Diseases and Immunology 2012;24: ) Kato K, Sato N, Takeda S, et al. Marked improvement of extensive atelectasis by unilateral application of the RTX respirator in elderly patients. Intern Med 2009; 48: Toshinori Minato MD, PhD Toyooka Hospital 1094 Tobera, Toyooka, Hyogo, , Japan Phone: Fax: toshinori-minato@toyookahp-kumiai.or.jp 6