Product presentation:

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• Product presentation

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Main goal of Paravent

• Paravent is a high-frequency jet ventilator
  aiming to complement conventional respirators in
  the clinical or critical situations hardly
  solvable by conventional means of ventilation
  (not to replace or compete with them)
• Primary advantages / distinguishing features from
  other respiratory products (HF ventilators as
  well as conventional ventilators) are
• true advantages of high-frequency jet ventilation
  (higher oxygenation, no interference with
  spontaneous breathing, etc.)
• introduction of Inpulsion and Expulsion effects
  (lung lavage)
• ventilation of full weight and age spectrum of
  patients on the single ventilators (from neonatal
  to over-weight adults)
• ventilation over a longer distance (up to 10 11
  m)
• possibility to ventilate more than two patients
  on single device

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Brief theoretical background of HFV
There are critical clinical conditions (when not
possible to ensure adequate alveolar ventilation
with the use of the conventional ventilation or
its modifications) that require the resolve with
the non-conventional ventilation methods.

• Examples of such cases are
• Cases related to decrease of compliance of lungs
  and decrease of functional residual capacity
  (lungs fibrosis, aspiration pneumonia, advanced
  ARDS, obstruction of breathing motions, e.g.
  while backfilled by soil, other statuses
  characterised by limited chest movement)
• Bilateral disparity of mechanical characteristics
  of lungs and thorax (unilateral trauma of lungs
  and thorax, diaphragmatic hernia, bronchopleural
  fistula, alar pneumonia).
• Cases with non-uniform mechanical characteristics
  of the same side of lungs (emphysema bulosum).
• Cases when minimal pressure effects of artificial
  ventilation of lungs lead to heavy disorder of
  hemodynamics (cor pulmonale, natal heart defects,
  hypovolemia).
• Extreme operative acts on trachea, bronchi or
  lungs.
• Such clinical cases gt cause an issue to secure
  the adequate alveolar ventilation using
  conventional approach. Appropriate resolve to the
  mentioned cases is
• High-Frequency Ventilation

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High Frequency Lung Ventilation (HFV)

• HFV is
• artificial lung ventilation where
  supra-physiologic frequencies of ventilation
  cycles are being used (frequencies exceeding 60
  80 cycles/min in compare, spontaneous breathing
  frequencies are 10 40 breaths/min in adults and
  up to 60/min in small children)
• divided into several groups (according to
  frequencies and type of technology)
• 1. HFPPV (High frequency positive pressure
  ventilation), freq. from 60 to 200 b/min.
• 2. HFJV (High frequency jet ventilation), freq.
  applied 80 600 b/min
• 3. HFO (High frequency oscillation), freq.
  exceeding 600 b/min.

High-Frequency Jet Ventilation (HFJV) has the
most application modes at present. The so called
Czech and Slovak type of HFJV characterized by an
original physical principle, original theory and
technical solution is a special sub-unit in the
specialty (invented by Mr. Ing. Ondrej Brychta,
CSc.).
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High-frequency jet ventilator

• the latest in the PARAVENT line (Paravent P, PA,
  PAT)
• Improvements in the product
• possibility of ventilation frequency switching
  from conventional frequency to high-frequency
  (HF)
• controlled electronically (mains feed or internal
  reserve power supply)
• further possibility to work as pneumatic device
• All features in a single device (used for
  neonatal and adult applications)
• based on more than 20 years of experience and
  testing results of HFJV research on clinical and
  experimental working sites in Czech republic and
  Slovakia
• Based on the concept of so called Multi-Nozzle
  Jet Injector (MNJI)

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Multi-Nozzle Jet Injector (MNJI)

• a set of different sizes of MNJIs (range 3mm up
  to 10mm in diameter)
• ventilator performance change is given by
  adaptation of MNJIs to intubation cannules which
  are adapted to different patient sizes
• consists of 3 inspiratory and 1 expiratory
  nozzles
• each insufflation nozzle gt different diameter gt
  enable to change ventilator performance (Pgmax)
  in a 100 range by changing the insufflation hose
  connection site to particular chosen nozzles
  (I,II,III) without changing the driving pressure
  (PIN)

• The Set of MNJIs allows
• safe and comparable ventilation of all weight and
  age spectrum of patients, including new-born
  babies (600 grams (premature babies) up to 140 kg
  (adults)
• Application of the expulsion and inpulsion effects

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Advantages of HFJV

• Physiological and medical advantages
• non-interference with spontaneous ventilation
• programmable movement of extraneous matters
  (Expulsion and Inpulsion mode) cleaning of
  airways using HFJV (as a supplement to
  conventional long-term ventilation)
• Expulsion and Inpulsion as a healing process for
  extraction of aspiration or little extraneous
  matter (e.g. dust, dirt) and application of
  pharmaceuticals (lavage)
• decreases the volume of lung extra-vascular
  water
• rising PEEP in 0,5 kPa 5 cm H2O
• lower Pawmax than in conventional ventilation
  (ca. 30)
• low risk of barotrauma
• application in bronchopleural fistula (lower
  leak of gases)
• slight increase of diuresis
• not necessary to interrupt external cardiac
  massage (chest compressions) during CPR (for
  artificial inspirium) improved transport of O2
  and SpO2
• in cases of lung oedema, HFJV is sovereign
  method of ventilation support

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Advantages of HFJV (cont.)

• Technological advantages
• easy use and application (fast switch on and set
  up of patient)
• application by non-invasive method (mask) easy
  applicability for paramedics as well
• long-distance ventilation (up to 10 m by use of
  special kit) crashes, disasters in mines,
  tunnels, blocked patient in a car wrack, etc.
• ventilation while patient in anaesthesia in
  examinations in Nuclear magnetic resonant tunnels
• crisis management (HFJV ensures at least minimal
  ventilation required for patient to survive even
  in the cases of compressed thorax and stomach,
  e.g. buried by ground)
• trans-tracheal application as a possibility
  (crisis management in no intubation no
  ventilation situations)
• possibility to use single ventilator for
  ventilation of patient from weight range from 600
  g up to 150 kg
• possibility of selective bi-bronchial ventilation

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Advantages of HFJV (cont.)

• Technological advantages
• possibility of urgent ventilation of two
  patients at the same time with single unit e.g.
  in transportation
• ventilation during bronchoscopics,
  bronchographics, including extraction of contrast
  media (filling) at the end of bronchgraphics
• application of healing aerosol, also during
  ventilation by mask (nebulizer)
• use in special applications ventilation in
  contaminated space, e.g. by chemicals or gas,
  etc.
• catheter ventilation in surgery of airways
• prevention of aspiration in use of unsealed
  (uncuffed) endotracheal tube
• use in emergency vehicles use by paramedics or
  doctors in emergency rescue systems
• easy and fast application in natural disasters
  and mass accidents
• Paravent contains limiter of maximal pressure in
  airways - total stop

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Points to consider for HFJV

• higher demand for experience in long application
  in ICU
• necessity of proper training of paramedics and
  doctors (users)
• issues with humidifying (Paravent is mostly used
  for short-term high-frequency jet ventilation
  without humidifying, or for longer-term
  application by the use of mask)
• long-term applications require special
  humidifying system
• in non-adequate application e.g. with the use
  of non-original components risk of barotraumas
  is high (use only with original components)
• swift changes of blood gases - hypocapnia
• possibility of monitoring of MV (minute volume)
  and VT (tidal volume) (only approximation)
• in non-adequate application of Expulsion or
  Inpulsion modes flush out of surfactant and
  creation of yatrogenous ARDS
• necessity of monitoring Paw (Pt)
• occasional issues with sealing of mask on
  patients face (e.g. moustache, anodontia,
  deformations, trauma) in HFJV by mask
• HFJV is absolutely contraindicated in severe
  astma, or other cases with serious bronchospasm

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Application ranges users
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1. Ventilation in critical cases model -urgent
ventilation
Target Users Emergency Medical Service (EMS),
Cardio Pulmonary Resuscitation (CPR), Delivery
Room, Rescuers, standby ventilation in the case
of electric current damp or ventilator failure in
the critical care unit etc. - generally in cases
that require instantaneous support

• Important advantages
• acknowledged contribution of HFJV as such
• simplicity and safety of operations with
  Paravent (performance determined by the selection
  of the suitable endotrachael tube (ETT) and
  corresponding MNJI and corresponds with the
  weight category of the patient)
• minimized personnel attendance in ventilator
  set-up
• also advantageous ventilation with untight ETT

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2. Transportation
Target Users Primary transportation requiring
ventilation support EMS Secondary
transportation Critical Care Unit (CCU),
Intensive Care Unit (ICU), Pathological New-born
Unit (PNU) (secondary transportation including
inside oneroentgenology, computer tomography
examination, operating theatre, etc.)

• Important advantages
• as mentioned earlier
• the possibility of spontaneous ventilation,
  respectively hard ventilation with superposition
  of HFJV on spontaneous breathing
• patients depression and dependency on
  ventilator is decreased
• non-existence of interference with ventilator
• brings down the necessity of intubation and
  relaxation

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Two Patients Ventilation Before and During a
Transport

• One of the obvious problems of premature twins
  transport -gt ventilation with two ventilators
  needed
• gt simple and efficient resolve by HFJV /
  Paravent
• possibility to ventilate premature twins as well
  as two adults (similarly sized as well as from
  two different weight categories, e.g. 12 kg child
  and 80 kg adult)

Paravent ventilators are the only mass produced
ventilators enabling differentiated ventilation
of more than one patients at once, suitable for
transport and resuscitation ventilation.
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3. Airways cleaning / lavage of lungs /
Tracheo-bronchial Toilette
Target Users CCU, delivery room, PNU, ICU during
conventational ventilation for lavage, mucolytics
instalation, suction etc. Of significant use the
possibility of longer manipulation in the airways
without necessity to interrupt ventilation
especially in the case of limiting hypoxy status

• Important advantages
• possibility of realization of inpulsion and
  expulsion mode of HFJV during conventional
  ventilation - predominant contributions of HFJV
  for clinical practice
• Inpulsion mode
• - for application of mukolytics, therapeutic
  aerosols, local anaesthetics, catecholamines
  etc. with the use of lavage valve
• Expulsion mode
• - for mobilization / extraction of
  expectorations, foreign body (dirt, vomit, etc.)
  or other obstructions from distal part of
  breathing ways (accumulated at ET tube from
  where drained without traumatization of mucous
  gt very good results in chronic obstructive
  bronchopulmonal disease, massive aspiration,
  atelectation -gt significantly reduced time need
  for ventilation, lower mortality of critical care
  patients

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Example of inpulsion and expulsion modes
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4. Critical care and intensive care model
-Resuscitation and intensive care
Target Users Critical Care Unit (CCU), Intensive
Care Unit (ICU), Pathological New-born Unit (PNU)
or Pediatric ICU (PICU)

• Important advantages
• airways ventilation analog to periodical
  respiration ambuing
• short-term hyperventilation in the case of
  intracranial hypertension with significant
  decreasing of intracranial pressure
• certain hypoxy status cases not reacting to
  conventional ventilation manoeuvres
• replacing of ventilators and breathing circuits,
  etc.

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5. Mask ventilation model (Non-invasive HFJV
Ventilation)

• Target Users
• Critical Care Unit (CCU), Intensive Care Unit
  (ICU), Pathological New-born Unit (PNU)
• in clinical practice, HFJV-M is a nearly ideal
  way to solve ventilatory problems in cardiac and
  non-cardiac lung edema, used in cases of
  recurarisation in the post-operative period, in
  chest trauma, partial respiratory insufficiency,
  replacing of ventilators and breathing circuits,
  airways ventilation analog to periodical
  respiration ambuing, certain hypoxy status
  cases not reacting to conventional ventilation
  manoeuvres, etc.

• Important advantages
• a noninvasive ventilatory support
• quick application and low aggressivity gt no
  need for sedation or anaesthesia for intubation
• doesnt interfere with spontaneous breathing
  (doesnt exclude patients cooperation)
• HFJV-M significantly decreases ventilation work
  gt crucial in any acute respiratory failure
  situations

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Example of connection of MNJI to face-mask for
HFJVM application
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6. Bronchoscopy / Jet relief bronchography
Target Users Critical Care Unit (CCU), Intensive
Care Unit (ICU), Pathological New-born Unit
(PNU), Roentgenology

• Bronchoscopy
• modification of bronchoscope in a way that MNJI
  is attached to the proximal end of the tubus
  (ventilation during the whole procedure)
• intubation using a thinner ET tube (size 4-5)
  without a cuff (enough space for flexible
  bronchoscope)
• intubation with larger ET tube and MNJI -gt
  flexible bronchoscope introduced through MNJI and
  ET tube into the bronchial tree

• Jet relief bronchography
• instillation of contrast substance (radioopaque
  medium) via inpulsion mode (create fine relief
  filling of airways)

• Important advantages
• minimizes amount of the instilled contrast
  substance and possible complications
• lavage possibility in inpulsion and expulsion
  modes

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7. Special applications in otolaryngologic and
thorax surgery

• Bi-bronchial or selective synchronous lungs
  ventilation
• there is a wide range of lung pathologies
  affecting lungs unilaterally (pneumonia,
  contusion, haematoma etc.) gt require selective
  lung ventilation the way that healthy and
  impaired lungs will be ventilated differently in
  accordance with their actual status
• possibility of selective ventilation of
  particular bronchi during broncho-pulmonary
  surgery
• For otolaryngologic surgery in the larynx area
  with specially adapted ventilation
  instrumentation for the subglottic and
  supraglottic ventilation.
• cleanliness of the operational area
• comfort of operator and patient
• increases ventilation safety during the action
• For special lung surgery possibility of
  synchronous selective ventilation for operations
  for open bronchus, lung resection, etc.

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8. HFJV during special examination in Nuclear
magnetic resonant tunnels
The ventilation issue all parts of ventilation
circuit must be non-magnetic (ventilation with
ventilation tubes long as much as 10m) HFJV by
Paravent ventilator offers an effective resolve
by use of 10 11 m long hose and MNJI
(non-magnetic) without the risk of significant
change of parameters of the fictive circuit
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9. Other special applications (examples of
critical cases)

• Application after being landed-up, in Cases of
  Decreased Compliance of the Rib-cage, in
  Ichtyosis, etc.
• Ventilation of patients unable to breathe because
  of extreme pressure applied to their thorax and
  abdomen (application of conventional ventilation
  in these situations ineffective (no space for
  chest and diaphragm movements)
• HFJV proves very effective, ensures satisfactory
  gas exchange in majority of cases enabling
  bringing off the victim
• Solution in Upper Airways Critical Obstruction
• gain life saving time necessary for the
  preparation of a proper tracheostomy or other
  intervention
• as an alternative solution in extreme emergency
  cases, an application of a special bi-lumen
  needle advanced into trachea with following
  trans-tracheal HFJV

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9. Other special applications (examples of
critical cases)

• HFJV application in Extraordinary Situations
• HFJV by specially adapted Paravent ventilators
  (according to customers requirements) can be
  applied in extraordinary situations such
• mass accidents
• blasts in chemical factories, air contamination,
  military attack (via face mask or intubation -
  apply neutralizing or therapeutic solutions after
  toxic, corrosive (e.g. chlorine) or hot gas
  inhalation
• remote ventilation mode in patients trapped in
  narrow shafts (ventilation by 10-11 m long
  connecting tubes)

• Important advantages
• simple to use, attended by paramedics or
  emergency medical technicians when trained in
  intubation or who can handle ventilation in
  transported patients previously intubated by a
  physician

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Contribution of Paravent ventilatorsin the
Clinical Practice

• Conclusion for Paravent ventilator
• a simple ventilator dedicated for artificial lung
  ventilation in emergency medical service,
  short-term use in patient transport between
  wards, operating theatres and cardiopulmonary
  resuscitation or longer-term, non-invasive use by
  face-mask (possibility of longer-term use with a
  need of humidification)
• allows a possibility to use it in all age and
  weight groups (capable to ventilate children with
  body weight of 600g and adults up 150 kg of body
  weight)
• introduces the inpulsion and expulsion effects
  and resulting applications (lavage, move out
  mobile bodies - foreign bodies, mucus, aspirate,
  etc.)

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???Please ask any of your questions.Thank you
for your attention.
ContactKalas, s.r.o.Tel. 421 907
066623E-mail info_at_kalas.skWeb www.kalas.sk