Introduction

The objective of this questionnaire is to map the variety of equipment available in the clinical field
such as:nCPAP system, humidifiers, breathing circuits, prongs and bonnets.

Our aim is to design a nebulising system that is, as much as possible, universal so that it could be
compatible with as many as possible typical equipment present in a NICU for the purpose of giving
nCPAP to preterm babies.

The questions below (pag 2 – 10)are aimed at collecting a precise database of what is in use in the
NICU to support the development work.

VENTILATORS OVERVIEW:

In general ventilators can be divided into:

- Ventilators for invasive mechanical ventilation that can be used also for non invasive support
- Ventilators for non invasive support only

Our nebulisation system is design to be compatible with any ventilators that provides non invasiveventilator
support with some exceptions highlighted below.

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Questionnaire approvedfor external use
Questionnaire:

1. Please complete the following information:

Hospital name:
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NICU level
3
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Hospital address:
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Profession:

Doctor Nurse XPharmacist  Other 

Would you be happy for us to contact you? If yes please fill in with your Email contact

iulianapasalan@yahoo.com

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2. What type of ventilatorsdevices do you have available in your NICU that can be used for delivering
CPAP (even if you do not currently use it for this purpose)?
Please tick all type of devices that are present in your NICU and specify how many of them.
In case additional type of devices were present please note them down and be as accurate as
possible with the type of devices and note both manufacturer and model (e.g. Manufacturer:
Acutronic, Model: Fabian HFO see picture below).

Example of one ventilator: Manufacturer:

Model

Manufacturer Model Number of ventilators

Draeger Babylog 8000 1

Draeger Babylog VN500
Acutronic Fabian HFOi
Acutronic Fabian HFO 2
Acutronic Fabian + nCPAP 2
Leoni Plus 3
SLE 5000
SLE 2000 1
Others: Others:

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Questionnaire approvedfor external use
3. Which type of humidifier do you have in your NICU that may be used to humidify air in combination
with a CPAP device?
Please tick all type of humidifiers that are present in your NICU and how many of them.
In case additional type of humidifiers were present please note them down and be as accurate as
possible with the type of humidifier and note both manufacturer and model (e.g. Manufacturer:
Fisher&Pykel, Model: M850 see picture below).

Manufacturer

Example of one humidifier:

Model

Manufacturer Model Number of humidifier

Fisher&Pykel MR850 7
Fisher&Pykel MR290
Fisher&Pykel MR810
Fisher&Pykel MR730
Wilamed AIrcom
Others:AQUAVENT Others: 2

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Questionnaire approvedfor external use
4. Which type of breathing tubesdo you have in your NICU that may be used to humidify air in
combination with a humidifier?  
Please tick all type of breathing tubes that are present in your NICU.
In case additional type of breathing tubes were present please note them down and be as accurate
as possible with the type of breathing tubes and note both manufacturer and model (e.g.
Manufacturer: Fisher&Pykel, Model: RT265 see picture below).

Example of one breathing tubes: Manufacturer

Model

Manufacturer Model Flag if present

Fisher&Pykel RT265 X
Fisher&Pykel RT268
Fisher&Pykel RT220
Wilamed BTS1154A
Others:AQUAVENT Others: X

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Questionnaire approvedfor external use
 5. Which type of prongs do you have in your NICU that may be used as an interface to deliver CPAP?  

Please tick all type of prongs that are present in your NICU.

In case additional type of prongs were present please note them down and be as accurate as
possible with the type of humidifier and note both manufacturer and model (e.g. Manufacturer:
Inspiration, Model: Inspire see picture below).

Example of patient interfaceprongs:

Manufacturer:
Inspiration

Model:
Inspire

In particular we would like to know whether you use the Inspire nCPAP prongs by inspiration (See picture
above).
YesNo 

Please be aware that in different countries they might be under different name. Please note the different
distributor name:
…………………………………………………………………………………………………………………………

Manufacturer Model Flag if present

Inspiration InspirenCPAPprongs
Covidien-Medtronic ArgylenCPAP nasal cannula
Fisher and Paykel Infant Nasal prongs
Hudson RCI/Teleflex Infant nasal Prong CPAP cannula
Neotech RAM Cannula
Intersurgical nFlow nasal prongs
Carefusion Infant Flow LP Nasal prongs
Draeger BabyFlow Prongs
OthersMEDIN Others:MINIFLOW,MEDJET X

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Questionnaire approvedfor external use
 HEINEN LOWENSTEIN NEOJET X
STEPHAN X

6. Which type of masks do you have in your NICU that may be used as an interface to deliver CPAP?  

Please tick all type of masks that are present in your NICU.

In case additional type of masks were present please note them down and be as accurate as
possible with the type of masks and note both manufacturer and model (e.g. Manufacturer:
Inspiration, Model: Inspire mask).

Example of patient interface mask: Manufacturer:

Inspiration

Model:
Inspire nCPAP Mask

Manufacturer Model Flag if present

Inspiration InspirenCPAPmask
Fisher and Paykel Infant Nasal Mask
Intersurgical nFLow nasal Mask
Carefusion Infant Flow LP Nasal Mask
Draeger BabyFlowNeoMask
Others:MEDIN Others:MEDIN X

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Questionnaire approvedfor external use
7. Which type of bonnetand straps do you have in your NICU that may be used while delivering CPAP?
Please tick all type of bonnetsand straps that are present in your NICU.

In case additional type of bonnets were present please note them down and be as accurate as
possible with the type of bonnets and straps and note both manufacturer and model (e.g.
Manufacturer: Draeger, Model:BabyFLow Bonnet).

TYPE A: example of bonnet with holes and straps tighten

in it
Manufacturer:
Inspiration

Model:
Inspire nCPAP Bonnet

TYPE B: example of bonnet and straps with Velcro:

Manufacturer:
Draeger

Model:
BabyFlow Bonnet

TYPE C: example of bonnet with straps integrated in it:

Manufacturer:
Carefusion

Model:
InfantFlow LP Bonnet

Manufacturer Model TYPE (A, B, C) Flag if present

please specify
Inspiration Inspire nCPAP Bonnet Type A
Covidien-Medtronic Argyle Baby Bonnet-Security Type C
Cap
Fisher and Paykel Infant Bonnet Type C X
Fisher and Paykel Infant head Gear Type C
Draeger BabyFLow Bonnet Type B
Carefusion Infant Flow LP bonnet Type C
Others:MEDIN Others: X
STEFHAN X

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Questionnaire approvedfor external use
8. Which type of incubators do you have in your NICU?  Please tick all type of incubators that are
present in your NICU.

In case additional type of incubators were present please note them down and be as accurate as
possible with the type of incubators and note both manufacturer and model (e.g. Manufacturer:
Draeger, Model:Caleo see picture below).

Manufacturer

Examples of incubator

Model

Manufacturer Model Flag if present

Draeger Caleo X
Draeger Babytherm 8004/8010 X
GE Healthcare Giraffe incubator carestation X
Fanem 1186 C
Phoenix INC 100
Others ATOM Others RABEE INCU X
DRAGER C 2000 X
DRAGER AIR SHIEDS X

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9. The nebuliserwill work ONLY with some types of ventilators. It cannot be used with variable flow
CPAP such as Infant flow, Medijet, Arabella, SensorMedics CPAP or generator-SIPAP. For our
nebulizer you will need to switch to another CPAP device during the nebulization. At the end of the
treatment you can decide which CPAP generator to use.

Do you currently use variable flow CPAP?

YesNo X

If yes, would it be acceptable to use another CPAP device for the duration of the treatment?

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10. What is the procedure or protocol in your hospitals for sterilizing reusable devices e.g.
lanryngoscope
AUTOCLAVABLE
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11. What is the procedure or protocol in your hospitals for disinfecting reusable devices e.g. drivers?
AUTOCLAVABLE
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Questionnaire approvedfor external use