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Safe use of Hamilton Medical ventilators on patients with highly infectious diseases

Article

Author: Uwe Scherzer

Date of first publication: 05.01.2021

Last change: 19.10.2020

Use of standby function is decision of clinician
This article gives you an overview of possible measures that may be taken to ensure protection against internal contamination of the ventilators, as well as protection of patients and clinical staff.
Safe use of Hamilton Medical ventilators on patients with highly infectious diseases

Measures to avoid contamination

As the novel coronavirus (2019-nCoV) continues to spread and has now been declared an international emergency by the WHO, questions regarding the safe use of Hamilton Medical ventilators on patients with highly infectious diseases are becoming more frequent.

We therefore recommend implementing the following measures to avoid contamination:

  • Follow the instructions for use of the ventilator and consider the WHO guidelines (Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. World Health Organization, Geneva, 2014. 1​, Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected Interim guidance. World Health Organization, Geneva, 2020. Licence: CC BY-NC-SA 3.0 IGO2​).
  • Use an inspiratory bacterial and viral filter to assure non-contamination of the internal ventilator gas path.
  • Protect the expiratory valve with a hydrophobic bacterial and viral filter.
  • For active humidification, as with a HAMILTON-H900 humidifier, use a bacterial and viral filter on the inspiratory and expiratory port of the ventilator (hydrophobic version). 
  • For passive humidification, use a bacterial and viral HME/HMEF filter between the proximal flow sensor and the patient to protect the airway against contamination. Be aware of changes in anatomical dead space and airway resistance, and exchange the filters regularly. 
  • Contamination of the flow sensor tube connectors is avoided due to permanent rinse flow through the flow sensor tubing towards the patient.
  • The Stand-by function can be used prior to disconnecting the ventilator from the patient to avoid mucus dispersion from the circuit. This decision should be made by the responsible clinician based on the situation of the individual patient.
  • Use single-use consumables such as breathing circuits, flow sensor, airway adapters, expiratory valves, and filters to minimize the risk of cross-contamination when the ventilator has been cleaned and set up for a new patient. 
  • Disinfect the outer surfaces of the ventilators during ventilation or after treatment of a patient with a registered hospital disinfectant. Consult the hygiene specialist in your facility regarding the appropriate disinfectant and follow the instructions for use of the manufacturer, particularly with respect to contact time.
  • For suctioning, use a closed inline suction system only.
  • Reduce the need for user interaction with the ventilator by using Hamilton Medical’s INTELLiVENT-ASV (Not available in the US and some other marketsA​) mode for intubated patients. INTELLiVENT-ASV continuously adapts ventilation to the patient condition and requires fewer interactions by clinicians (Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-73​, Arnal JM, Garnero A, Saoli M, Chatburn RL. Parameters for Simulation of Adult Subjects During Mechanical Ventilation. Respir Care. 2018;63(2):158-168. doi:10.4187/respcare.057754​). 
  • All turbine-driven Hamilton Medical ventilators (HAMILTON-C1/C2/C3/T1/MR1 and HAMILTON-C6 (Not available in all countriesB​)) are equipped with high-grade HEPA filters to keep the interior airway free of contamination. There is no need to change the HEPA filters more frequently than indicated in your regular maintenance plan.

Make sure that all clinical staff involved in the handling of the ventilator are informed about the above-mentioned measures. 

This information is available for download below.

Footnotes

  • A. Not available in the US and some other markets
  • B. Not available in all countries

References

  1. 1. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. World Health Organization, Geneva, 2014. 
  2. 2. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected Interim guidance. World Health Organization, Geneva, 2020. Licence: CC BY-NC-SA 3.0 IGO
  3. 3. Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7
  4. 4. Arnal JM, Garnero A, Saoli M, Chatburn RL. Parameters for Simulation of Adult Subjects During Mechanical Ventilation. Respir Care. 2018;63(2):158-168. doi:10.4187/respcare.05775

Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care

Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. World Health Organization, Geneva, 2014. 

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected Interim guidance. World Health Organization, Geneva, 2020. Licence: CC BY-NC-SA 3.0 IGO

Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients.

Beijers AJ, Roos AN, Bindels AJ. Fully automated closed-loop ventilation is safe and effective in post-cardiac surgery patients. Intensive Care Med. 2014;40(5):752-753. doi:10.1007/s00134-014-3234-7

Parameters for Simulation of Adult Subjects During Mechanical Ventilation.

Arnal JM, Garnero A, Saoli M, Chatburn RL. Parameters for Simulation of Adult Subjects During Mechanical Ventilation. Respir Care. 2018;63(2):158-168. doi:10.4187/respcare.05775



BACKGROUND

Simulation studies are often used to examine ventilator performance. However, there are no standards for selecting simulation parameters. This study collected data in passively-ventilated adult human subjects and summarized the results as a set of parameters that can be used for simulation studies of intubated, passive, adult subjects with normal lungs, COPD, or ARDS.

METHODS

Consecutive adult patients admitted to the ICU were included if they were deeply sedated and mechanically ventilated for <48 h without any spontaneous breathing activity. Subjects were classified as having normal lungs, COPD, or ARDS. Respiratory mechanics variables were collected once per subject. Static compliance was calculated as the ratio between tidal volume and driving pressure. Inspiratory resistance was measured by the least-squares fitting method. The expiratory time constant was estimated by the tidal volume/flow ratio.

RESULTS

Of the 359 subjects included, 138 were classified as having normal lungs, 181 as ARDS, and 40 as COPD. Median (interquartile range) static compliance was significantly lower in ARDS subjects as compared with normal lung and COPD subjects (39 [32-50] mL/cm H2O vs 54 [44-64] and 59 [43-75] mL/cm H2O, respectively, P < .001). Inspiratory resistance was significantly higher in COPD subjects as compared with normal lung and ARDS subjects (22 [16-33] cm H2O/L/s vs 13 [10-15] and 12 [9-14] cm H2O/L/s, respectively, P < .001). The expiratory time constant was significantly different for each lung condition (0.60 [0.51-0.71], 1.07 [0.68-2.14], and 0.46 [0.40-0.55] s for normal lung, COPD, and ARDS subjects, respectively, P < .001). In the subgroup of subjects with ARDS, there were no significant differences in respiratory mechanics variables among mild, moderate, and severe ARDS.

CONCLUSIONS

This study provides educators, researchers, and manufacturers with a standard set of practical parameters for simulating the respiratory system's mechanical properties in passive conditions.

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