Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Jul 11;27(1):65.
doi: 10.1186/s13049-019-0643-1.

Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude

Marc Blancher  1 , Maxence Repellin  2 , Maxime Maignan  2   3 , Cyrielle Clapé  2 , Arnaud Perrin  2 , José Labarère  4 , Guillaume Debaty  2   5 , Damien Viglino  2   3
Affiliations
Comparative Study

Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude

Marc Blancher et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). This is particularly important during transportation of critically ill patients by helicopter emergency medical services (HEMS), where altitude may influence device performance. Because weight is a real concern in HEMS, new low-weight devices are very appealing. The aim of this study was to compare infusion flow rates delivered by low-weight versus standard SIP devices, in the prehospital emergency medicine setting, at different altitudes.

Methods: We conducted a comparative bench study involving five SIP devices (two standard and three low-weight models) at 300, 1700 and 3000 m altitude. The primary endpoint was the flow rate delivered by SIPs for prespecified values. We used two methods to measure flow. The normative method consisted in measuring weight (method A) and the alternate method consisted in measuring instantaneous flow (method B).

Results: Using method A, no significant differences were found in median flow rates and interquartile range depending on device and altitude for a prespecified 10-mL/h flow. However, method B showed that low-weight SIPs delivered multiple sequential boluses with substantial variations (1.2-15.8 mL/h) rather than a prespecified continuous 5-mL/h flow. At 1700 m altitude, the interquartile range of delivered flows increased only for low-weight devices (p for interaction< 0.001).

Conclusions: Despite satisfactory normative tests, low-weight SIPs deliver discontinuous flow with potential clinical implications for critically ill patients receiving vasoactive drugs. This study also highlights a thus far unknown negative impact of altitude on SIP function. We believe that normative requirements for SIP approval should be revised accordingly.

Keywords: Air med; Altitude; Emergency helicopter; Emergency medicine; Intensive care unit; Mountain rescue; Syringe infusion pump; Vasoactive drugs.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Syringe infusion pumps
Fig. 2
Fig. 2
Infusion profiles measured using method A depending on SIP models. A: DPS Orchestra®; b: Agilia Injectomat®; c: Micrel Micropump 1; d: Micrel Micropump 2
Fig. 3
Fig. 3
Infusion profile measured using method B (instantaneous flow, CORI-FLOW™ flow meter) at 300 m (a) and 1700 m (b) altitude, set at 5 ml/h
See this image and copyright information in PMC

References

    1. Bouzat P, Ageron F-X, Brun J, Levrat A, Berthet M, Rancurel E, et al. A regional trauma system to optimize the pre-hospital triage of trauma patients. Crit Care. 2015;19:111. doi: 10.1186/s13054-015-0835-7. - DOI - PMC - PubMed
    1. Warren J, Fromm RE, Orr RA, Rotello LC, Horst HM, American College of Critical Care Medicine Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256–262. doi: 10.1097/01.CCM.0000104917.39204.0A. - DOI - PubMed
    1. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S, et al. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005;33:533–540. doi: 10.1097/01.CCM.0000155912.73313.CD. - DOI - PubMed
    1. Genay S, Décaudin B, Lédé S, Feutry F, Barthélémy C, Lebuffe G, et al. In vitro comparison of two changeover methods for vasoactive drug infusion pumps: quick-change versus automated relay. Biomed Tech (Berl) 2015;60:377–380. doi: 10.1515/bmt-2014-0140. - DOI - PubMed
    1. Greau E, Lascarrou J-B, Le Thuaut A, Maquigneau N, Alcourt Y, Coutolleau A, et al. Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study. Ann Intensive Care. 2015;5:40. doi: 10.1186/s13613-015-0083-7. - DOI - PMC - PubMed

Publication types