Abstract
BackgroundIntravenous 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.MethodsWe 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).ResultsUsing 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).ConclusionsDespite 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.
Highlights
Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs)
For prespecified flow rate set at 10 millilitres per hour (mL/h) (Table 1), the weight measurement method did not show any significant differences in median infusion flow rate and interquartile range depending on the device (p = 0.83 and p = 0.27, respectively) and altitude (p = 0.15 and p = 0.71, respectively)
No significant first-order interaction was observed between devices and altitude levels for median flow rates (p = 0.32) and interquartile range (p = 0.66)
Summary
Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). These devices have undergone high-level technological development They allow constant delivery of flow in intravenous circulation by adapting the pushing power delivered into the syringe to the flow resistance in infusion lines (adapting the type of syringes, extension lines, and/or catheters) and to intravascular pressure prevailing at the injection site. They are part of the usual medical equipment for prehospital medical management of patients in a critical condition, in countries with physician-staffed services using ground ambulances, air ambulances or helicopter emergency medical services (HEMS), and for those with medical mountain rescue services. These devices must be adapted to the some extreme conditions related to the prehospital transportation, whenever possible meeting specific needs in terms of low weight, size and resistance
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