23/03/2013

1

PNEUMOBELT

Ft Vilma Donizetti

PNEUMOBELT

FT Vilma Donizetti

Valduce Hospital

“Villa Beretta” Rehabilitation Center

Costa Masnaga, Lecco (I)

THE ORIGINS…

1938, the Bragg-Paul Pulsator

Corset or belt around the chest

Air sac or bladder

Intermittent inflation by a

positive pressure ventilator

THE EVOLUTION…(modern

IAPV: Exsufflation Belt, Pneumobelt,

Pneumatic Belt)

Abdominal (customized)

corset

Elastic inflatable bladder

Worn beneath the patient’s

outer clothing

2 2

3

NORMAL BREATHING

INSPIRATION (active) EXSPIRATION (passive)

1 1

3

BREATHING THANKS TO

PNEUMOBELT

EXPIRATION (forced) INSPIRATION ( passive)

2

1 2

1

4

3

INSUFFLATION

OF THE

BLADDER

UPWARD

DISPLACEMENT

OF ABDOMINAL

CONTENTS AND

DIAPHRAGM

ASSISTED

EXPIRATION

DEFLATION

OF THE

BLADDER

DIAPHRAGMATIC

DROP

PASSIVE

INSPIRATION

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2

COMPONENTS POSITIONING

The upper portion should

extend to the xiphoid

process, just above the

lower level of the ribs, to

prevent paradoxic motion of

the rib cage during

exalations.

Lower curved border:

well over epigastric

region

Optimal corset size (small, medium, large) and

tightness for ventilation and comfort is found

by trial and error

VENTILATOR’S CHARACTERISTICS

Portable volume or pressure ventilator

Capable of delivering up to 2,500 ml volumes or

pressures to 60 cmH2O

( higher pressure alarm ≥ 60 cmH2O or higher

volume alarm ≥ 2000 ml)

A good battery ( at least 5-6 hours)

Conditions for use:

INDISPENSABLE

Sitting position:

a trunk angle of 30° or more

from horizontal (optimally 75°)

A corset firmly tightened

A syncronization of the patient’s

breathing pattern with the

ventilator

>30°

Adeguate lung and chest wall compliance

No severe kyphoscoliosis or back deformity

No obesity or excessive thinness

Usually for patient with severe respiratory

insufficiency:

“the less the free time ( less than 1 hour), the greater the

preference for the IAPV over mouth IPPV”. J.Bach

Conditions for use:

PREFERABLE

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DURING THE NIGHT….. CAN YOU USE IT?

Its NOCTURNAL USE is limited only to patients

who can sleep sitting upright

SETTING: HOW?

Increasing the pressure the pressure/volume to

minimize the patient’s component to his total tidal

volume (usually 30-50 cmH2O)

Patient asymptomatic for hypoventilation (no dyspnea)

End tidal CO2 < 45 mmHg

No oxyhemoglobin desaturation

Authors Rates

breath/min

Pressures

Miller HJ ( Arch Phys Med Rehabil 1989; 70:707-11)

12-14 50-60

cmh2O

Alexander MA ( Arch Phys Med Rehabil 1979; 60:289-92)

50 cmh2O

Bach JR, Alba A (Chest 1991; 99: 630-36)

17.3+/-2.8 42.1+/-4.6

cmH2O

Milane J., Jonquet O.,

Bertrand P.

(Eur Respi Rev, 1993; 3: 12, 305-307)

40-55

cmH2O

Hill NS (Chest 1986; 90:897-905)

16-28 >45 cmh2O

SETTING: IN LITERATURE

IN THIS MODALITY

INSPIRATORY TIME IS EXPIRATORY

TIME!!

IN THIS MODALITY

TRIGGERING IS NOT POSSIBLE

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RESULTS

Patient becomes asymptomatic for hypoventilation

(no dispnea, respiratory compensation)

VT > 200 ml

SaO2

CO2

Relationship of tidal volume (TV), pressure (P) and

thoracic posture (°) for one patient.

ADVANTAGES

Incospicous (privacy, cosmesis)

Simple to use and wear

Face/ mouth/ nose completely free

Portable

Easily installed on a wheelchair

Good daily option for patient h24

BUT ALSO…..

Benefits derived:

Helping the patient to belch and to pass flatus

Assisting the patient in clearing secretions (by glottic

closure just prior to an abdominal compression)

Increasing motility of intestine

Higher tono of voice/ improved speech

P riorityV entilating with a cold

8%

S peaking/ Tone of

voic e

8%

S melling

8%

Increas ing the

intes tinal motility

17%

R educ ing the ris k of

nos e s ores 17%

E ating-drinking

42%

Activity is permitted only by

pneumobelt Eating

Drinking

Smelling

Coughing better

Speaking longer and better

Higher tone of voice

Sleeping sitting on the wheelchair (respect to mouth IPPV)

Reducing the risk of nose sores

Increasing intestinal motility

Reducing the risk of alteration of the face, teeth and

chewing

Wearing glasses and readig, watching tv

Ventilating with a cold

Personal hygiene/ make-up

NORMAL MULTI DIMENSIONAL VOICE ANALYSIS

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WITH PNEUMOBELT

WITHOUT PNEUMOBELT

Without P.

23 10 12

With P.

23 10 2012

With P.

08 11 2012

Performance

mt 95 130 260

SB at rest 0,50 0,50 0,50

SB at 6' 10 8 8

FC at rest 91 87 92

FC at 6' 101 96 89

Sao2 at rest 95 96 95

Sao2 at 6' 97 95 94

CHANGING QUALITY OF LIFE:

A CASE PAZ 5. Female, 54 years,

diagnosis of Congenital

Myasthenia

Without a specific training, freeing the patient to walk in the hospital

A CASE:

Male, 41 years,

diagnosis of ataxic-

paraparetic syndrome

Safety Level

VAS

0 no

10 maxim

S afety L evel

0

2

4

6

8

10

P T Z 1 P T Z 2 P T Z 3 P T Z 4 P T Z 5 P T Z 6 P T Z 7 P T Z 8 P T Z 9

7,3 average

Ventilation Hours /24h

0

4

8

12

16

20

24

P T Z 1 P T Z 2 P T Z 3 P T Z 4 P T Z 5 P T Z 6 P T Z 7 P T Z 8 P T Z 9

Ho

urs

Total hours P neumobelt hours

AND WHAT ABOUT THE PRESSURE BLADDER?

119 ml

119 ml

Thanks to dr M. Cazzaniga

191 ml

322 ml First stimulus

Urgency stimulus

with Pneumobelt Urodynamics in pts with

neurogenic bladder

70

70 cmH2O 100% Patients say:

- no problems with urinary and/or fecal

incontinence before and after using ( max 4

years) Pneumobelt.

- they have to urinate more frequently

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FEW DIFFICULTIES…..

Food regurgitation during meals (rarely)

Clothing catching on the corset buckles ( straps and

Velcro closures)

Redness at bony prominences

No shower or bath

PAY ATTENTION TO…..

PNEUMOBELT is not THE solution

for every patient bus it could be

A GOOD ALTERNATIVE modality

of ventilation to be used in combination

with others and a good opportunity to

offer to improve QUALITY OF LIFE

of ONE of your many patients.