Today on the show, I talk with my friend Jim DuCanto, MD about the oxylator. Jim is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way.
What is the Oxylator?
A mainly plastic device about the size of your fist with a incredibly quick magnetic valve
It runs on pressurized wall or tank oxygen
Only two main controls, a pressure setting knob and a manual inhalation/automatic mode button
Manual Resuscitator Mode
Press the button and the device will give 30 lpm of inhalation until you let go or it hits the pressure limit you set
Automatic Ventilator Mode
Press in the button and give it a turn and the device switches to automatic ventilation mode. Think of it as a flow-controlled, pressure cycled ventilator in your hand
It gives 30 lpm fixed flow (slow, safe flow) until it hits the user-selectable pressure limit, it then cycles to passive exhalation until it reaches 2-4 cm H20 PEEP and then it begins a new breath
On a patient who is not spontaneously breathing, you can titrate that pressure setting to an inhalation time of 1-2 seconds; this will deliver 500-1000 mls per breath
At those settings, the minute volume will be 10-12 liters/minute
The device indicates when you are obstructing by clicking and tells you when there is a mask seal leak by not cycling to the next breath
It Solves the 5 Problems of the BVM
- We give too many breaths
- Those breaths are at too high a pressure
- The breaths are given too rapidly
- We get no feedback on whether the breath went in or it was given against an obstructed airway
- In a spontaneously breathing patient, the BVM will give variable FiO2s depending on the exhalation port
How we use it
We both use an inline hepa filter, ETCO2 port, and sometimes extension tubing. If you want to use it on a spontaneously breathing patient, OR mask straps are a great addition.
EMX (25-45 cm H20) and HD (15-30). There are also specialty models for chemical/explosive situations.
Here is Jim's Overview on the Device
And here are the Slides from a lecture Jim gave at SAM
Here is an example of the use of the Oxylator for an OR Induction
Nasal CPAP in Unconscious Patient is More Effective than Full-Face Masks
Oxylator Product Page
This is the EMX Model
Disclaimer and COI
Neither Jim nor I take any money, kickbacks, or incentives from the manufacturer. Both Jim and I have been provided with Oxylators to test and research.
Now on to the Podcast…
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020