TY - JOUR T1 - Effect on FIO2, Flow, and Filter Resistance in COVID-19 Filtered Tracheostomy Patient Breathing Circuit JF - Respiratory Care VL - 65 IS - Suppl 10 SP - 3440407 AU - Leonid Rabkin AU - William R Howard AU - Joseph Previtera AU - Matthew W Howard Y1 - 2020/10/01 UR - http://rc.rcjournal.com/content/65/Suppl_10/3440407.abstract N2 - Background: Exposure to environmental airborne pathogens may result in infections associated with significant morbidity and/or mortality. 1 Strategies to prevent hospital-acquired pneumonia is to avoid transmission of microorganisms with use of Venturi air entrainment devices. 2 Care for COVID-19 positive patients mechanically ventilated for prolonged periods of time eventually required tracheostomy tube placement. We managed these patients who successfully weaned from the ventilator with a traditional open-ended heated and humidified gas circuit. Clinician concerns led to a suggestion to protect escape of pathogens and we wanted to know if our intervention affected delivered flow, FIO2 and flow resistance. Methods: A Teleflex Neptune heater provided heated and humidified gas, (Teleflex, Inc., Morrisville, NC). To the ChonchaSmart column we connected a Teleflex 1605 bacterial/viral filter to protect the patient from environmental pathogens. The filter connected to an F&P RT008 adjustable air entrainer, (Fisher & Paykel Healthcare, Irvine CA). The entrainer connected to a 0-15 L/m O2 flow meter using standard small-bore tubing. A Teleflex 870-19KIT single-limb adult ConchaSmart heated-wire circuit attached to the column outlet. Connected to the distal end of the circuit was a Teleflex 1648 tee piece for connecting to a tracheostomy tube. To this tee piece was a 6-inches standard aerosol tubing reservoir. The patient side of the tee piece occluded so that all flow was directed towards the exhalation side of the circuit. Baseline measurements were measured using a calibrated TSI-4080 FA-Plus analyzer, (TSI Inc., Shoreview, MN) for flow and FIO2 at each setting of the diluter (28-90%). A Pall BB50-T hydrophobic filter, (PALL Corp., Parkland Court, IL) was added distal to the tubing extension. Repeat measurements were compared to baseline. Data were analyzed using two-sided Z-tests with P > 0.05 considered insignificant. Results: Baseline flow, FIO2, and filter resistance were compared to the measurements after 72 hours of administration. Flow MD (±SD) was 4.12 L/m (± 13.6 L/m) (P > 0.05). FIO2 MD (±SD) was 4.12 L/m (± 13.6 L/m) (P > 0.05). Filter resistance MD (±SD) comparing a filtered circuit to a non-filtered circuit was -0.17 cm H2O/L/m (± 0.04 cm H2O/L/m) (P > 0.05). Conclusions: Addition of an inspiratory bacterial/viral and expiratory hydrophobic filters to a heated-humidified circuit did not significantly alter the flow, oxygen concentrations, or filter resistance. ER -