Variable flow Whisperflow, Photograph by Steve LeCroy
31.2.2 Disposable CPAP Devices
Disposable devices attach to the low-pressure side of the regulator or flow meter (Boussignac®, Flow-Safe®, O-Two Controlled Ventilation™, and Rescuer® Emergency CPAP System) or to the high-pressure side (O2-RESQ™).
31.2.2.1 Boussignac
The disposable Boussignac CPAP device (Vygon; https://www.vygon.com/catalog/vygon-boussignac-cpap_572_00557013), first described by Dr. George Boussignac in 1989, was the first completely disposable CPAP devices. The principle behind the Boussignac valve is to increase the forward velocity of a gas by narrowing the flow through a cylinder. By increasing the velocity, turbulence is created within the device. It is the turbulence and friction within the cylinder that creates the resistance the patient must breathe against. All pressure adjustments are made by adjusting the flow rate to either increase or decrease the turbulence. This process eliminates the need for valves or moving parts. The valve is open, meaning that it is open to the atmosphere, allowing the patient to breath in room air as needed. The device incorporates a measuring port to add a manometer if needed. The manufacturer reports that CPAP of 10 cmH2O can be achieved with approximately 25 l/min of oxygen flow.
31.2.2.2 Flow-Safe
Photograph courtesy of Mercury Medical
Flow-Safe (Mercury Medical; http://mercurymed.com/home/) is a completely disposable CPAP device featuring a built-in manometer to monitor airway pressure and a pressure relief valve for patient safety. There are three versions of Flow-Safe: the original Flow-Safe, Flow-Safe II, and Flow-Safe II EZ. Each device uses the same principle to create pressure. Similar to the Boussignac, the Flow-Safe device changes the velocity of the gas by narrowing the flow. The increased gas flow creates the inspiratory pressure to assist the patient to inhale and also provides the PEEP during exhalation. Pressure adjustments are made by increasing or decreasing the gas flow rate from the flow meter or regulator and monitoring the built-in manometer. According to the manufacturer, the original Flow-Safe achieves pressures from 1.5 to 10 cmH2O with oxygen flow rates of 10–25 l/min. Flow-Safe II achieves the same pressures as the original Flow-Safe using lower flow rates, however, the trade-off is a slightly lower FiO2. Flow-Safe II EZ incorporates a built-in nebulizer, allowing both the valve and the nebulizer to be powered from a single gas source.
31.2.2.3 O-Two Controlled Ventilation
The O-Two Single-Use CPAP device (O-Two Medical Technologies; http://otwo.com/emergency-cpap/o_two-single-use-cpap/) is completely disposable. Adjustment of pressure levels occurs by adjusting the flow rate from the flow meter or regulator. Pressure and flow rate settings are found on the body of device. According to the manufacturer, the CPAP range is between 5 and 20 cmH2O at flow rates of 8–25 l/min.
Photograph by Steve LeCroy
31.2.2.4 O2-RESQ
The O2-RESQ (Pulmodyne; http://www.pulmodyne.com/products/pre-hospital-and-emergency-medicine/o2-resq-product-information/) is an expansion chamber with a Venturi air entrainment port. The basic unit provides approximately 30 % FiO2 at a continuous flow up to 140 l/min to meet patient demand. CPAP valves are available from 2.5 to 20 cmH2O and provide constant pressures at any flow rate. With the addition of the O2-MAX™ Trio adaptor, FiO2 can be adjusted from 30% to 60% or 90%. CPAP valves, snapped onto the anti-asphyxia housing end of the circuit, are used to maintain PEEP pressures.
31.2.2.5 Rescuer Emergency CPAP System
Rescuer Emergency CPAP (BLS Systems; http://blssystemsltd.com/cpap_em.html) incorporates an oxygen reservoir that, according to the manufacturer, allows higher FiO2 levels with low flow rates, saving oxygen. The device also has filters on both the inhalation and exhalation side to reduce exposure to airborne pathogens. With the addition of the Rescuer II compact, a smaller version than the original BLS Rescuer, BLS Systems now offers a version with a built-in manometer. The device can also be configured to power a small volume nebulizer directly off the CPAP device.