title: CPAP Devices for Emergency Prehospital Use: A Bench Study.
abstract: BACKGROUND
  CPAP is frequently used in prehospital and emergency settings. An air-flow output minimum of 60 L/min and a constant positive pressure are 2 important features for a successful CPAP device. Unlike hospital CPAP devices, which require electricity, CPAP devices for ambulance use need only an oxygen source to function. The aim of the study was to evaluate and compare on a bench model the performance of 3 orofacial mask devices (Ventumask, EasyVent, and Boussignac CPAP system) and 2 helmets (Ventukit and EVE Coulisse) used to apply CPAP in the prehospital setting.
  
  
  METHODS
  A static test evaluated air-flow output, positive pressure applied, and FIO2 delivered by each device. A dynamic test assessed airway pressure stability during simulated ventilation. Efficiency of devices was compared based on oxygen flow needed to generate a minimum air flow of 60 L/min at each CPAP setting.
  
  
  RESULTS
  The EasyVent and EVE Coulisse devices delivered significantly higher mean air-flow outputs compared with the Ventumask and Ventukit under all CPAP conditions tested. The Boussignac CPAP system never reached an air-flow output of 60 L/min. The EasyVent had significantly lower pressure excursion than the Ventumask at all CPAP levels, and the EVE Coulisse had lower pressure excursion than the Ventukit at 5, 15, and 20 cm H2O, whereas at 10 cm H2O, no significant difference was observed between the 2 devices. Estimated oxygen consumption was lower for the EasyVent and EVE Coulisse compared with the Ventumask and Ventukit.
  
  
  CONCLUSIONS
  Air-flow output, pressure applied, FIO2 delivered, device oxygen consumption, and ability to maintain air flow at 60 L/min differed significantly among the CPAP devices tested. Only the EasyVent and EVE Coulisse achieved the required minimum level of air-flow output needed to ensure an effective therapy under all CPAP conditions.
authors.affiliation: Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Sezione Anestesia e Rianimazione, Università degli Studi di Genova, Genova, Italy. claudia.brusasco@gmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: Brusasco
authors.affiliation: SC Anestesia e Rianimazione, EO Ospedali Galliera, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corradi
authors.affiliation: Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Sezione Anestesia e Rianimazione, Università degli Studi di Genova, Genova, Italy. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Genova, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Ferrari
authors.affiliation: Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Sezione Anestesia e Rianimazione, Università degli Studi di Genova, Genova, Italy. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Genova, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ball
authors.affiliation: Department of Anesthesiology and Critical Care and the Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.affiliation: Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Sezione Anestesia e Rianimazione, Università degli Studi di Genova, Genova, Italy. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Genova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
mesh_terms: D000399:Air Pressure; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004632:Emergency Medical Services / Q000379:methods*; D005540:Forced Expiratory Flow Rates; D006801:Humans; D008397:Masks; D008962:Models, Theoretical; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation*; D012123:Pulmonary Ventilation
keywords: Boussignac; acute respiratory failure; ambulance; cardiogenic pulmonary edema; emergency department; helmet CPAP; noninvasive CPAP