Air Liquide EOVETM-70 Electric Mucus Suction Pump User Guide

Air Liquide EOVETM-70 Electric Mucus Suction Pump

Product Information

The EOVETM-70 is a versatile device that combines complementary treatments for upper airways, lower airways, middle airways, and deep lung. It is equipped with INEX IPPB (Intermittent Positive Pressure Breathing) that delivers an air volume beyond the patient’s current volume. The device is designed to help optimize and maintain respiratory function, proximal clearance, and distal clearance.

Mode Explanations

• PRESSURE: Mechanical in-exsufflation delivers positive pressure, followed very quickly by negative pressure, which assists coughing.
• IPPB: This recruitment mode delivers an air volume beyond the patient’s current volume. It enables the patient to reach the inspiratory reserve volume. This improves pre-cough volume and mobilizes the thoracic wall.
• FLOWRATE: The selected flowrate modulates the inspiratory cycle time. Two possible options depending on the treatment objective. The high-flow setting effectively delivers a volume of air over a reduced inspiratory time. Slow insufflation allows maximum intake in all lung areas to reach the inspiratory reserve volume.

Indications and Contraindications

• Indications: The EOVETM-70 is indicated for patients with respiratory issues.
• Contraindications: Airway obstruction, hyperinflation, pneumothorax, severe emphysema and recent lobectomy, increased intracranial pressure, altered consciousness, lack of cooperation, severe bulbar palsy, cardiac instability, esophageal fistula, rib fractures.

Product Usage Instructions

Starting a Session: Define Comfort Settings

To begin the session, follow these instructions:

1. Support the patient to inhale a larger volume than their current volume.
2. Reassure the patient that as they start breathing in through the mouthpiece, the EOVETM-70 will deliver air to them.
3. Allow the patient to be inflated by the device, without forcing themself to breathe in.
4. When the device stops delivering air, the session has started.

Settings INEX

The following are the settings for INEX:

• Operating modes: Automatic/Manual
• Inspiratory pressure: 5 to 70 cmH2O
• Inspiratory time: 0.5 to 5 sec
• Inspiratory slope: 0 to 5
• Auto-Trigger Pause: OFF/1 to 3
• PEEP: OFF/1 to 20 cmH2O
• Expiratory pressure: 0 to -70 cmH2O
• Expiratory time: 0.5 to 5 sec
• Oscillations: Inspiration/Expiration

Settings IPPB

The following are the settings for IPPB:

• Inspiratory flowrate: 5 to 100 L/min
• Inspiratory trigger: OFF/8 levels
• Maximum pressure: 10 to 50 cmH2O
• Maximum time: 0.5 to 20 sec
• Expiratory slope: 5 levels OFF/1 to 20 cmH2O
• Insufflation speed: Continuous flowrate: constant flowrate during inspiration, decelerating flowrate: flowrate gradually decreases to the target pressure.

Note: To rinse the circuit, we recommend setting the expiratory slope to 1 and PEEP to 4 cmH2O.

The EOVETM-70 is a versatile device combining complementary treatments

Mode explanations

• INEX
  Mechanical in-exsufflation delivers positive pressure, followed very quickly by negative pressure, which assists coughing.

• IPPB= Intermittent Positive Pressure Breathing

  • This recruitment mode delivers an air volume beyond the patient’s current volume.
  • It enables the patient to reach the inspiratory reserve volume. This improves pre-cough volume and mobilizes the thoracic wall.
    The selected flowrate modulates the inspiratory cycle time Two possible options depending on the treatment objective

Indications and contraindications

• Indications INEX
  • Peak Cough Flow (PCF) when coughing < 160 L/min
  •  Congestion
  • Thoracic wall diseases
  • Any patient with a PCF lower than 270 L/min will benefit from INEX
• Indications IPPB
  • Low PCR
  • Congestion
  • Decreased thoracic wall or pulmonary compliance
  • Restrictive syndromes
  • Forced vital capacity less than 60% of theoretical capacity

General contraindications applicable to both INEX and IPPB
Airway obstruction, hyperinflation, pneumothorax, severe emphysema and recent lobectomy, increased intracranial pressure, altered consciousness, lack of cooperation, severe bulbar palsy, cardiac instability, esophageal fistula, rib fractures.

Settings

INEX

Inspiratory slope

| ****

0 to 5

| Speed at which the pressure will be reached:

1/5th Ti, 2/5th Ti, etc.

Auto – Trigger| OFF/1 to 3| Allows the patient to trigger their cycle
Pause| OFF/0.5 to 5 sec| Pause between expiration and inspiration
PEEP| OFF/1 to 20 cmH2O| Positive pressure during pause
Expiratory pressure| 0 to -70 cmH2O| –
Expiratory time| 0.5 to 5 sec| –
Oscillations| Inspiration/Expiration| Amplitudes| OFF/3 levels
Frequency| OFF/4 to 20 Hz

IPPB

Inspiratory flowrate

| ****

Continuous flowrate/ Decelerating flowrate

| Continuous flowrate: constant flowrate during inspiration

Decelerating flowrate: flowrate gradually decreases to the target pressure

Inspiratory trigger| OFF/8 levels| Allows the patient to trigger their cycle
Maximum pressure| 10 to 50 cmH2O| Pressure at which inspiration stops The patient can then exhale

Maximum time

| ****

0.5 to 20 sec

| If the patient has not reached the max pressure at the end of the maximum inspiratory time, the cycle

will proceed to expiration Maximum inspiratory phase time

Expiratory slope| 5 levels| Gradual decrease in expiratory pressure to the set PEEP
PEEP| OFF/1 to 20 cmH2O| Positive pressure during pause

Starting a session: define comfort settings

IPPB
Support the patient to inhale a larger volume than their current volume.

• Reassure the patient:
  1. As you start breathing in through the mouthpiece, the EOVETM-70 will deliver air to you.
  2. Allow yourself to be inflated by the device, without forcing yourself to breathe in.
  3. When the device stops delivering air, you can exhale.
  4. The exercise will take place at your pace: you decide when to start breathing in again.

INEX
Help the patient identify the inspiratory and expiratory phases so that they can synchronize as much as possible.

1. The EOVETM-70 will deliver air to you.
2. Allow yourself to be inflated, but it is important that this is comfortable for you.
3. Next, the EOVETM-70 will suck out the air very quickly.
4. During this phase, I will ask you to exhale or cough. I will help you if necessary.

Installations and recommendations for treatment

• Settle the patient into position based on their functional state:
  • In a half-seated position in a bed
  • Sitting in a chair
• Opt for a position where the practitioner can easily apply manual coughing assistance in addition to the instrumental assistance
• If necessary, choose a personalized signal with the patient to indicate when to pause the insufflations (e.g. a wink)
• Ideally, use a mask that covers the nose and mouth with the INEX function
• Guide the patient with clear instructions:
  • Inhale or inflate
  • Cough hard

Proximal clearance

INEX

Objective
To simulate an effective cough to clear the patient’s lungs

Settings
Recommended settings:

Installation settings

Patient on NIV| Patient not on NIV
Initiate at:

Pi = PIP + 5 cmH2O Pe = PIP +10 cmH2O

| Initiate at:

Pi = 15 cmH2O Pe = – 20 cmH2O

Ti = Te = Ti (NIV) +0.5 s

Pause = 1 sec

| Ti = Te = 1 sec Pause = 1 sec

Adjustment:

• Inspiratory and expiratory pressures and times must be individualized and gradually increased until efficacy is achieved.

• The Ti/Te ratio must be adjusted according to the disease and the context.

• The Pinsp must be less than the Pexpi.

• Dose
  Depends on the extent of the congestion, example: 1 to 4 times a day; 2 to 5 cycles, pause when the patient needs a break.

• Post-treatment clinical assessment
  Improvement of the PCF, audible secretions, secretions in the upper airways.

IPPB

Objective
To increase inspiratory volume to facilitate effective coughing. IPPB enhances pre-cough volume to facilitate coughing.

Settings
Recommended settings:

• Flowrate: 30–50 L/min
• Max pressure: 30 to 40 cmH2O\

Adjustment:
Carried out by the physiotherapist during the session if there is an increase in bronchial hyperactivity:

• The flowrate and pressure must be individualized and gradually increased until a satisfactory pre-cough volume is achieved that enables effective coughing

•  PEEP: in the absence of abdominal deficiencies, increase PEEP gradually

• Dose
  1 to 4 times a day depending on the congestion Perform 2 to 5 movements followed by a cough; pause when the patient needs a break

• Post-treatment clinical assessment
  Sputum, displayed volume increased, patient clinical improvement, auscultation.

• Target patients

  • Congested patients with neuromuscular impairment: myopathy, tetraplegia.
  • Any congested patient whose dyspnea and/or exhaustion makes manual drainage ineffective.

Distal clearance

IPPB

Objective
To mobilize secretions present in the distal parts of the lung areas.

Settings
Recommended settings:

• Flowrate: 20 to 30 L/min
• Max pressure: 25 to 35 cmH2O

Adjustment:
If the pressure is reached too quickly or if the current volume displayed is too low: increase the inspiratory time by decreasing the flowrate and/or by adjusting the pressure gradually

• Dose

  • 1 to 4 times a day depending on the extent of the congestion.
  • Perform 2 to 5 insufflations followed by a cough; pause when the patient needs a break

• Post-treatment clinical assessment
  Sputum, displayed volume increased, patient clinical improvement, auscultation.

• Target patients

  • Congested patients with neuromuscular impairment: myopathy, tetraplegia
  • Any congested patient whose dyspnea and/or exhaustion makes manual drainage ineffective.

Respiratory function optimizationRespiratory function optimization

IPPB

Objective
To maintain or develop ventilation in hypoventilated lung areas.

Settings
Recommended settings:

• Flowrate: 10 to 30 L/min
• Max pressure: 25 to 35 cmH2O

Adjustment:
Performed according to the mobility observed during auscultation of the hypoventilated area:

• Flowrate: minimum

• Maximum pressure: gradual titration of the pressure in order to optimize the inspired volume

• Dose
  10 to 30 minutes per day, 5 days a week

• Target patients

  • Neuromuscular diseases
  • Multiple disabilities
  • Pre-surgery, post-surgery
  •  Any patient whose respiratory function is severely decreased, with sustained volume reduction

Respiratory function optimization

IPPB

Objective
To mobilize the chest cavity and let in as much air as possible.

Settings
Recommended settings:

• Flowrate: 20 to 35 L/min
• Max pressure: 30 to 40 cmH2O

Adjustment:
Depending on the volumes measured:

• Flowrate: increase or decrease depending on how the patient feels

• Max pressure: if resistance is high, do not hesitate to significantly decrease the pressure

• Dose
  10 to 30 minutes per day, 5 days a week

• Target patients

  • Neuromuscular diseases
  •  Multiple disabilities
  •  Pre-surgery, post-surgery
  •  Any patient whose respiratory function is severely decreased, with sustained volume reduction

ABOUT COMPANY

1. Respiratoire, 2014. Comparison of three cough-augmentation techniques in neuromuscular patients: mechanical insufflation combined with manually assisted cough, insufflationexsufflation alone and insufflation-exsufflation combined with manually assisted cough. Lacombe M1, Del Amo Castrillo L, Boré A, Chapeau D, Horvat E, Vaugier I, Lejaille M, Orlikowski D, Prigent H, Lafaso F.
2. AARC Clinical Practice Guideline. Intermittent Positive Pressure Breathing: 2003 Revision & Update. Sorenson HM, Shelledy DC, AARC.
3. Pediatric Pulmonology, 2006. IPPB-Assisted Coughing in Neuromuscular Disorders. Dohna-Schwake C, Ragette R, Teschler H, Voit T, Melies, U.
4. Arch. Bronconeumol., 2014. Comparison of intermittent positive pressure breathing and temporary positive expiratory pressure in patients with severe chronic obstructive pulmonary disease. Nicolini A1, Mollar E2, Grecchi B3, Landucci N2.

Contact

• Air Liquide Medical Systems
• Parc de Haute Technologie
• 6, rue Georges Besse
• 92182 Antony Cedex
• France
• www.device.airliquidehealthcare.com
• Air Liquide Healthcare is a global leader in medical gases, home healthcare, hygiene products and specialty healthcare ingredients. Its mission is to provide its customers, throughout the hospital-to-home care pathway, with medical products, specialty ingredients and services that help protect vulnerable lives.
• EOVETM-70 provides treatment for patients who are unable to clear their secretions by themselves. It offers an insufflation-exsufflation (INEX) mode and a pressure relieving mode (IPPB — Intermittent Positive Pressure Breathing) for adults and children – Class IIb medical device – CE 0459 – Manufacturer: EOVETM Read the user manual carefully.
• Air Liquide Medical Systems, Antony. Nanterre Trade and Companies Register No. 348 921 735

References

• Homepage | Air Liquide Medical Systems

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