Page 24 - JSOM Summer 2025

Enhancing Oxygen Therapy and Preserving Oxygen Resources
with the Double-Trunk Mask

Literature Review

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Frédéric Duprez, PhD, RT, PT *; Rida Cheikh Youssef, MD ; Joseph Antoun, MD ;
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François Waroquier, RN ; Frank Van Trimpont, MD ; Jean Baptiste Watelet, MD, PhD 6
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ABSTRACT
Background: The prehospital availability of oxygen resources Additionally, the volume and weight of O cylinders and bat-
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appears to be a critical limitation in military medicine. The teries for oxyconcentrators are high, and the O resupply chain
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fraction of inspired oxygen (FIO ) provided to patients is fre- is also sensitive to the versatile tactical environment.
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quently lower than their pathophysiological needs. This defi-
cit is due to the difficult mobilization of oxygen reserves and Thus, healthcare providers maximally restrict the delivered O
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the volatile tactical pressure. Although several oxygen deliv- flow rates to the casualty. Owing to these subsequent factors,
ery devices are on the market, few effectively achieve optimal the amount of oxygen delivered to patients is frequently insuf-
FIO levels. The double-trunk mask (DTM) represents a rev- ficient compared to their oxygen requirements. 2
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olutionary solution that significantly improves the efficiency
of oxygen delivery while conserving oxygen. The DTM is de- Oxygen cylinders are commonly used to provide oxygen in
rived from a conventional aerosol mask. It includes two 22mm war zones and disaster areas. However, they have a limited ox-
corrugated tubes secured in the side openings of the mask, ygen supply and require careful management due to the risks
each approximately 15 to 20cm in length in adults. Methods: involved. Without proper handling, there is a significant risk
Following PICO screening, 15 eligible articles (prehospital, of fire, injury, or death. 4
real-life settings, published 1990–2023 in English, Dutch, or
French) indicated the DTM’s mechanisms of operation and ef- In hospital emergency departments, intensive care units, or
ficacy. Results: DTM significantly improves oxygen delivery wards, O is classically administered through a nasal cannula
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while minimizing oxygen loss and improving pulmonary dif- (NC), oxygen mask, or non-rebreather mask (NRM). Ac-
fusion rates. The increase in PaCO is minimal despite the in- cording to the literature, the O flow through nasal cannulas
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crease in material dead space. Conclusions: This device proves should not exceed 6L/min, oxygen masks 10L/min, and non-re-
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invaluable when oxygen supplies are limited, such as during breather masks 15L/min. Several authors measured that the
pandemics or war. Its use maximizes administered FIO while lowest FIO is obtained through a nasal cannula, followed by
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minimizing oxygen consumption, optimizing patient care in an oxygen mask, and finally, a non-rebreather mask. How-
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resource-limited environments. ever, these systems, even when well selected and used, do not
always provide highly effective FIO levels. Moreover, for
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Keywords: oxygen therapy; oxygen supply; tactical environment; the same oxygen and inspiratory flow rate, the variations in
double-trunk mask; mass casualty events; disasters administered FIO among these systems are minimal. 6,10
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In order to improve the O delivery efficiency and to solve
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the O consumption issues, the double-trunk mask (DTM) was
Introduction 2
developed in the Intensive Care Unit of the Belgium Epicura
During mass casualties and operational medicine, oxygen (O ) Hornu Hospital. 11–14 The DTM is an innovative solution that
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resources must be considered a major limiting factor. There- significantly improves the efficiency of oxygen delivery while
fore, oxygen is usually strictly restricted to unstable trauma limiting O consumption. 15–18
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patients.
The primary objective of this review is to collect scientific ev-
The pathophysiological aim of supplemental O is to prevent idence on oxygen therapy with the DTM and whether using
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hypoxia and acidosis development rapidly. However, in war this mask can offer added value to the standard oxygenation
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or disaster areas, the practical use of supplemental oxygen- methods. The secondary objective is to describe the scientific
ation can be complicated by several factors, including the steps that supported DTM development. Finally, this manu-
high O volume needed for polytrauma encountered on the script aims to provide a comprehensive review of DTM and to
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battlefield and the limited practical access to O availability. assess the advantages and disadvantages of the device.
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*Correspondence to dtamedical@hotmail.com
1 Dr. Frédéric Duprez and Dr. Rida Cheikh Youssef are affiliated with the Department of ICU-URICE, Epicura Hospital, Hornu, Belgium. Dr.
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Joseph Antoun is affiliated with the Department of Internal Medicine, Epicura Hospital, Hornu, Belgium. OR9 François Waroquier, OF3 Frank
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Van Trimpont, and OF3 Jean Baptiste Watelet are affiliated with the Tactical Medical Training Cell (TacMed), Centre of Medical Expertise,
Belgian Defense, Neder over Hembeek, Belgium.
a Contributed equally to the work
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