5 min RTX video, take a look! I saw this at AARC Congress this year. It looks like it might have some amazing potentials. It has the ability to sense insp effort. NPSV? Check out the link RTX military BCVto the milatary model. Hayek RTX BCV

This message has been edited. Last edited by: GaryMefford,

Hi Gary,

I checked out the website. I couldn't get the audio to work, maybe I'm missing something.

Anyway the Hayek Oscillator has been out for a long time. I remember many years ago going to a conference in SF where one of the presentations was about it.

It's a negative pressure curass which can apply both positive and negative pressure, sense insp efforts and (apparently per video) do some CPT functions.

The photo of a child being taken off Bipap Helmet ventilation and put on an external chest wall ventilator was obviously meant to tug at the heart strings (and was probably better for the kid and family!). Certainly a lot of patients whom the MD's want to wear Bipap but whom are less than eager or compliant might be better served by some device like the Hayek (I can hear the nurses now!).

From my memory of the conference presentation the Hayek Oscillator could be used on an intubated ARDS patient with internal postive pressure ventilation and an external negative pressure baseline. It would be interesting if a Hayek Oscillator could be tethered to a vent such that postive pressure breaths could be augmented by negative pressure Hayek external AND exhalation could be enhanced via positive pressure Hayek external (probably want Drager ATC with Peep drop during exhalation).

One of my ideas would be to have "The Other Recruitment Manuever". (Copyright 2007 as "The Whitnack Manuever"). Imagine that some Medical God has decreed that your settings with positive pressure ventilation were ideal for the very severe ARDS patient. But still with that positive pressure it's like a big boot stomping on the ability of the lymphatic system to syphon away the edema fluid. So here comes the other recruitment maneuver---lymphatic fluid is drained away.

A patient is sedated/paralyzed. A ResQPod is placed on the end of the ET tube. An external Hayek Oscillator is attached. The patient is removed from the vent and a ResQPod attached to the end of the ET tube. !00% O2 is provided flow-by for any insp breath. First the Hayek Oscillator uses positive pressure to empty the lungs towards RV. Then the ResQPod is quickly attached and either 1) graded phrenic nerve stimulation is used to slowly fill up the lungs or 2) Hayek Oscillator applies negative pressure to slowly fill the lungs. And as the lungs fill the ResQPod's negative inspiratory pressure would help to suck up or recruit edema fluid into the lymphatic system. The Hayek may not be necessary as perhaps manual external lateral rib pressure could do the trick. But having a slow deep insp (can't go over negative 8 or 10 or veins collapse) would be the tricky part.

And of course patient safety such that brief removal from the vent would be OK.

Fixed the audio. Someone on my home PC set Windows sound to Mute. I always look for that at work (WHAT! No J Giels while I do billing after midnight?), but wonder which elf did that to my home PC. Will look at it later. Looking at the website without audio had me imagining humorous take offs--especially when initial presenter stepped in real close to camera.

Jeff,
Speaking of Milking the lympatic system. Whats your take on Dr. Birds theory of vesicular peristalsis:

An associated adjunctive function of Intrapulmonary Percussive Ventilation (IPV), is the enhancement of "Physiological Vesicular Peristalsis" within the Thoracic: Bronchial, Pulmonary and Lymph circulations. Uniquely, the technology employed in the design of the IPV/VDR apparatus, provides for the near instantaneous change over from flow to no flow gradients, during pulsatile intrapulmonary gas deliveries. The intrathoracic impactions by the "Pulsatile Percussive Energy" delivered within the Pulmonary Structures, serves to compress all vessels within the thoracic cage. For "Maximum Vesicular Peristalsis", the period of Expiratory Relaxation (Expiratory Time) must be longer than inspiration, preferably an i/e ratio of about 1:2.

The near intantaneous Flow Reversals from positive to negative, during the Inspiratory/Expiratoty/Inspiratory transitions (called "Transition Penalties)", are under seven (7) milli-seconds. This allows effective Intrathoracic Percussion, at frequencies of over 800 cycles per minute. Most effective Percussive Frequencies for "Mechanical Intrapulmonary Vesicular Peristalsis" are from 100 to 150 cycles per minute.

Directional flow through the three Intrathoracic circulations, is provided by their structural check valves. Flow through the cardiac circulation's are, Bronchial Circulation left to right, Pulmonary Circulation right to left..
Lymph within the Thoracic Interstitial Spaces, is evacuated by the extensive Lymphatic drainage system, dumping into the Venous Circulation through the Thoracic Duct.

The Lymph Circulation would be expected to receive the greatest enhancement from a "Mechanical Vesicular Peristalsis", because it is the lowest pressure system with the greatest distribution (with the greatest number of check valves), being totally dependent upon a "Physiological Thoracic Lymph Pumping action". Whenever the physiological Thoracic Lymph pumping system is compromised by disease or trauma, the retention of excess Protein in the Interstitial Spaces can lead to an Interstitial Edema, with a secondary decrease in the physiological "Pulmonary Vital Capacity".

The directional pressure/flow gradients within the Pulmonary Circulation, between the Right and left Atriums, are essentially zonally controlled by the cardiac chamber valves. Therefore, the Percussive Pulsatile Inflation and Deflation impactions, against the walls of the Pulmonary vessels, during "Intrapulmonary Percussive Ventilation" could serve to enhance the "Peristaltic Vesicular Peristalsis" created by the dynamic myocardial structures.

Augmentation of the Bronchial Circulation, with Intrapulmonary Percussive Ventilatory Programming, would be most effective within the Pulmonary Alveolar structures, after the major reduction in systemic arterial pressures has occurred.

Optimally, a high amplitude Intrapulmonary Percussive Ventilatory Program with a 1:2 i/e Ratio, at a delivery rate of from 100 to 200 cycles per minute, would provide for a reasonable segmental vesicular reloading time, with a Clinically Effective Stroke Volume.

Theoretically, the greatest Intrathoracic Vesicular Peristalsis may occur at Percussive IPV cycling rates of about two to three times existing Heart Rates, with a 1:2 i/e Ratio. It follows, the greater the impaction pressure (velocity of Sub Tidal Volume Delivery), the greater the propulsion forces.



Just curious. I also can not take credit for above writing it comes from Dr. Bird and percussionaires website.

Thanks Light,

I had heard a brief mention once that IPV (or VDR) helps augment lymphatic drainage. Thanks for providing that description. My read of it is that the pulsatile regimen of IPV is superior to conventional ventilation. I just wonder if even better would be to actually go sub atmospheric via some combination of Hyack Oscillator, spontaneous breathing, phrenic nerve stimulation, ResQPod, etc.

Sounds like a job for the Pig Lab!

Jeff,
One thing I see about it is that your set-up would be only once in a while, lets say Q4 to where the IPV and VDR is continuous. Plus alot more difficult to set-up cost of equipment and a little more out their than the IPV and VDR which some think is out there in its own right.

Well we're dealing with the IPV/VDR claims which I haven't seem really confirmed or explained for effect (how much difference does it really make? etc.) and comparing it to my admittedly potentially hair-brained idea and speculation.

But assuming both concepts valid (a small step for me, a giant step for a real scientist )....the VDR/IPV would be more akin to a gentle constant "milking" of the lymphatics as opposed to a more periodic but larger recruitment.