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. 2022 Apr 26:13:885898.
doi: 10.3389/fphys.2022.885898. eCollection 2022.

Oxygenation Performance of Different Non-Invasive Devices for Treatment of Decompression Illness and Carbon Monoxide Poisoning

Andrea Köhler  1 , Felicitas M Zoll  1 , Thomas Ploner  1 , Alexander Hammer  1 , Michael Joannidis  1 , Herbert Tilg  1 , Armin Finkenstedt  1 , Frank Hartig  1
Affiliations

Oxygenation Performance of Different Non-Invasive Devices for Treatment of Decompression Illness and Carbon Monoxide Poisoning

Andrea Köhler et al. Front Physiol. .

Abstract

Study Objective: Application of high concentrations of oxygen to increase oxygen partial pressure (pO2) is the most important treatment for patients with carbon monoxide intoxication or divers with suspected decompression illness. The aim of this study was to evaluate the oxygenation performance of various non-invasive oxygen systems. Methods: The effect of different oxygen systems on arterial pO2, pCO2 and pH and their subjective comfort was evaluated in 30 healthy participants. Eight devices were included: nasal cannula, non-rebreather mask, AirLife Open mask, Flow-Safe II CPAP device, SuperNO2VA nasal PAP device, all operated with 15 L/min constant flow oxygen; nasal high-flow (50 L/min flow, 1.0 FiO2), non-invasive positive pressure ventilation (NPPV, 12 PEEP, 4 ASB, 1.0 FiO2) and a standard diving regulator (operated with pure oxygen). Results: Diving regulator, SuperNO2VA, nasal high-flow and NPPV achieved mean arterial pO2 concentrations between 538 and 556 mm Hg within 5 minutes. The AirLife Open mask, the nasal cannula and the non-rebreather mask achieved concentrations of 348-451 mm Hg and the Flow-Safe II device 270 mm Hg. Except for the AirLife open mask, pCO2 decreased and pH increased with all devices. The highest pH values were observed with NPPV, diving regulator, Flow-Safe II and nasal high-flow but apparent hyperventilation was uncommon. The AirLife Open and the non-rebreather mask were the most comfortable, the SuperNO2VA and the nasal cannula the most uncomfortable devices. Conclusion: A standard diving regulator and the SuperNO2VA device were equally effective in providing highest physiologically possible pO2 as compared to nasal high-flow and NPPV.

Keywords: PaO2; arterial oxygen partial pressure; carbon monoxide poisoning; decompression illness; diving accident; non-invasive ventilation; oxygen masks.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The oxygen devices used in this study (A) Standard nasal cannula (B) Standard non-rebreather mask with expiration valves. (C) Air Life Open. An oxygen mask that allows patients to drink, eat and talk without removing the mask (D) Flow-Safe II. A CPAP device that can be used with a standard NPPV face mask and constant flow oxygen. (E) SuperNO2VA. A nasal PAP device also used with constant flow oxygen (F) Nasal high-flow with a Fischer&Paykel Airvo2. (G) Non-invasive positive pressure ventilation with a Dräger Carina (H) Standard diving regulator. Oxygen was delivered by a scuba tank.
FIGURE 2
FIGURE 2
Mean arterial pO2 (mm Hg) achieved with the different oxygen systems.
FIGURE 3
FIGURE 3
Mean arterial pH during breathing with the different oxygen systems.
See this image and copyright information in PMC

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