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Draeger Oxylog 3000 Use With Cpap/bipap


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#1 SnowPika

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Posted 03 April 2009 - 03:11 AM

Has anyone used the CPAP or BIPAP function on the Draeger Oxylog 3000? If so, how well did it work? Any insights? Our program will be getting these vents for RW shortly and for FW later. I would like to incorporate this function into protocol if other programs have had success with it. If you have any other general tips about the vent you can send those along as well!
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#2 LearRRT-CCEMTP

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Posted 03 April 2009 - 11:52 AM

Has anyone used the CPAP or BIPAP function on the Draeger Oxylog 3000? If so, how well did it work? Any insights? Our program will be getting these vents for RW shortly and for FW later. I would like to incorporate this function into protocol if other programs have had success with it. If you have any other general tips about the vent you can send those along as well!


If it's not too late, talk your program into cancelling the Oxylog and go for the Pulmonectics LTV-1200 with the graphics package! The Oxylog 3000 is nice but it comes in second to the LTV in patient care!
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#3 JLP

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Posted 03 April 2009 - 01:02 PM

If it's not too late, talk your program into cancelling the Oxylog and go for the Pulmonectics LTV-1200 with the graphics package! The Oxylog 3000 is nice but it comes in second to the LTV in patient care!


I'll second that - the LTV is a great vent and the graphics is soooooo nice, lets you see whats going on. I'm trying to talk our agency into hard-mounting the graphics screen into air A/C if they won't put them on each vent.
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#4 Tmed725

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Posted 03 April 2009 - 02:00 PM

I would disagree, the package, battery life and simplicity all make the Draeger a better unit for what we do. If you want a home care vent than the LVT is the way to go, but the last time I went to work we did not do home care.
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#5 LearRRT-CCEMTP

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Posted 04 April 2009 - 01:58 AM

I would disagree, the package, battery life and simplicity all make the Draeger a better unit for what we do. If you want a home care vent than the LVT is the way to go, but the last time I went to work we did not do home care.



Wow, what world are you in! The LTV is the perfect vent for transport and any RRT will tell you so. It is far more compatable to a hospital ventilator and the last time I checked, our goal was to maintain or improve the level of care for transports. I know of NO home care programs utilizing the LTV-1200 for home vent patients. The LTV-800, LTV-850, and even the LTV-900 are great homecare vents but the LTV-1000 and LTV-1200 are clinical ventilators and are way to complex and expensive for home use. There may be a random few cases of patients utilizing the 1000 but by no means can you call it a home care vent!
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David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT
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#6 ST RN/PM

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Posted 04 April 2009 - 01:20 PM

Lear RRT,
Your points are well taken. However, the Drager is a lot lighter, does have better battery life, and honestly, performs the same functions as the Drager for the purposes of critical care transport of many adults and children. I must profess my ignorance of the respective ventilators' functions for highly specialized ventilatory modes and their uses for kids/neonates, (which seems to be the specialty of you and many other RRTs that post). I do not often have out-of-the-ordinary modes of ventilation.
As far as adults go, for 85% of the transports that I do (for both rotor wing and ground CCT), the Drager and LTV-1000 and 1200 are identical in function with a few minor idiosyncratic differences, and the quietness/size/functionality of the Oxylog 3000, make it my preferred vent.
As for the home care issue, I have seen more than a few LTV 1000s used in home care. Yes, the 1000 and 1200 with the graphics screen are excellent clinical ventilators. I have no argument for that. If the program that you work for encounters a lot of patients with stiff lungs, extensive pulmonary disease and children/neonates, there is no substitute for the extra "set of eyes" that the screen provides.
Please explain why in your opinion the LTV is so much more compatible to a hospital ventilator than the Drager. I am not an RRT, but I do have a decent grasp of transport ventilator functionality and use the LTV and Drager on a regular basis. Help me understand why a ventilator that performs volume and pressure ventilation, non-invasive ventilation, has built-in PEEP, has pressure control/pressure support capability, CPAP/BiPAP capability with varying ramp capabilities, and can be used for APRV/AC/SIMV/PS..... is not as compatible to hospital ventilators as the LTV. (I am not being sarcastic, I am looking for your input to help me and others reading these posts).
As for the initial response for SnowPika..... I have used both CPAP and BiPAP with the Drager, and have had no major issues at all. As with any transport ventilators, you will have varying patient responses, and the transition can sometimes be difficult requiring "tweaking". Several times, I have had to increase the IPAP from the hospital's settings for patient comfort. Adjusting the ramp is often helpful as well for assisting the patient in tolerating the transition to the transport vent. Taking a few minutes prior to departure from the bedside to comfortably transition the patient is what I try to do if the transition is initially difficult, because this allows time to assess the source of the difficulty (increased anxiety vs. different pressure delivery etc.).
Respectfully, Steve
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Steve T. RN, PM

#7 FloridaMedic

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Posted 04 April 2009 - 03:30 PM

I would disagree, the package, battery life and simplicity all make the Draeger a better unit for what we do. If you want a home care vent than the LVT is the way to go, but the last time I went to work we did not do home care.


Being simple and having a good battery life are not the only features that should be considered when choosing a ventilator.

Yes, the LTV is a very popular homecare ventilator and Christopher Reeve did an excellent job promoting its use. However, not all insurances will cover its cost and may be difficult to get. The LTV 1000 is now easier to obtain since it is an older model. the reason it is popular is due to its versatility. Even if a patient is in homecare, there is no need for them to stop the weaning process or have a ventilator adapt to them during rehab exercises which many will continue to get while at home.

Both are good ventilators but when purchasing one, you should look at the spec sheet just as if you were buying an expensive car for performance.

The LTV is one of the few transport ventiators that I have seen handle the difficult ICU patients even when they must be switched from whatever complex ICU ventilator mode for transport. The internal PEEP feature has made a difference in maintaining a good MAP if we must transport someone who has been on HFV.

Max Peak Inspiratory Flow, use of working pressure, sensitivity and demand valves all play a role in the choice of a ventilator. Modes are only one part of the selection process. This is also why graphics are very importand and why some RRTs have strong opinions about some ventilators. They have watched the graphics and the patients' reactions on various ventilators and understand the weakness in some ventilators for delivery. Also, many of the weaning modes such as SIMV (old school) may look impressive as the ventilator appears to offer a lot of "modes" but may be of little use in the field. These are designed to impress the sub-acutes. PSV and PCV are good options only if your ventiator is effective in delivering adequate flow to max the inspiratory demand. If the peak flow is inadequate, these modes may be ineffective on some patients and can increase WOB or anxiety. The Newport HT50 has in the past been an example of this.

Also, when using different machines for NIV or PSV, one must understand whether it is IPAP from 0 or if the machine starts IPAP from EPAP. That must be determined when moving the patient from one vent to another and can make a big difference. IPAP 15/ EPAP 5 may actually be a pressure support of 10 on some machines and 15 on others.

http://www.viasyshea...00_Brochure.pdf

http://www.draeger-m...ylog3000_br.pdf
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#8 LearRRT-CCEMTP

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Posted 04 April 2009 - 08:14 PM

Lear RRT,
Your points are well taken. However, the Drager is a lot lighter, does have better battery life, and honestly, performs the same functions as the Drager for the purposes of critical care transport of many adults and children. I must profess my ignorance of the respective ventilators' functions for highly specialized ventilatory modes and their uses for kids/neonates, (which seems to be the specialty of you and many other RRTs that post). I do not often have out-of-the-ordinary modes of ventilation.
As far as adults go, for 85% of the transports that I do (for both rotor wing and ground CCT), the Drager and LTV-1000 and 1200 are identical in function with a few minor idiosyncratic differences, and the quietness/size/functionality of the Oxylog 3000, make it my preferred vent.
As for the home care issue, I have seen more than a few LTV 1000s used in home care. Yes, the 1000 and 1200 with the graphics screen are excellent clinical ventilators. I have no argument for that. If the program that you work for encounters a lot of patients with stiff lungs, extensive pulmonary disease and children/neonates, there is no substitute for the extra "set of eyes" that the screen provides.
Please explain why in your opinion the LTV is so much more compatible to a hospital ventilator than the Drager. I am not an RRT, but I do have a decent grasp of transport ventilator functionality and use the LTV and Drager on a regular basis. Help me understand why a ventilator that performs volume and pressure ventilation, non-invasive ventilation, has built-in PEEP, has pressure control/pressure support capability, CPAP/BiPAP capability with varying ramp capabilities, and can be used for APRV/AC/SIMV/PS..... is not as compatible to hospital ventilators as the LTV. (I am not being sarcastic, I am looking for your input to help me and others reading these posts).
As for the initial response for SnowPika..... I have used both CPAP and BiPAP with the Drager, and have had no major issues at all. As with any transport ventilators, you will have varying patient responses, and the transition can sometimes be difficult requiring "tweaking". Several times, I have had to increase the IPAP from the hospital's settings for patient comfort. Adjusting the ramp is often helpful as well for assisting the patient in tolerating the transition to the transport vent. Taking a few minutes prior to departure from the bedside to comfortably transition the patient is what I try to do if the transition is initially difficult, because this allows time to assess the source of the difficulty (increased anxiety vs. different pressure delivery etc.).
Respectfully, Steve



Steve,
You answered you own question with your last paragraph. FloridaMedic also answered it very well. My issue with the Oxylog 3000 while trialing it was that the Oxylog 3000 did not meet the flow demands of many patients and the graphics were far inferior to that of the LTV and also pretty useless. When I pick up a stable patient that is comfortable on the settings on their hospital vent and place them on the LTV-1200, I have to make little to no changes in flight as long as they remain clinically stable. With the Oxylog 3000, I found myself spending a great deal of time having to "play" with the vent in order to try and make my patient comfortable. I don't have to do that with the LTV! The issue is several things, first the Oxylog utilizes flow triggering just like the LTV but the most sensitive you can go down to is 3 Lpm, the LTV goes down to 1 Lpm. There are many very frail, week patients that 3 Lpm is just too much of a change for them to be able to comfortably trigger. Secondly, when hooked up to an external gas source the Oxylog 3000 only delivers a flow rate of 80 Lpm with 51 PSI or less (which is what most onboard systems are) and 100 Lpm with >51 PSI. The LTV is capable of delivering 160 Lpm of flow which is about the same as most hospital vents and makes a world of difference! The 4 lbs heavier makes all the difference in the world! The additional flow can mean more comfort, less sedation, and better care! As for the graphics, the LTV graphics are as good as any hospital vent's and better than a few. The Oxylog has just a couple pressure graphs (like the Impact 754 Eagle) so it can advertise graphics and they are pretty useless. You really need flow waveforms, and flow-volume curves and others to adequately manage a vent during transport! These reason are why in my opinion the LTV-1200 far exceeds the Oxylog 3000 and every other transport vent currently available on the US market!
Stay Safe,
Dave
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David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT
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#9 LearRRT-CCEMTP

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Posted 04 April 2009 - 08:24 PM

Lear RRT,
Your points are well taken. However, the Drager is a lot lighter, does have better battery life, and honestly, performs the same functions as the Drager for the purposes of critical care transport of many adults and children. I must profess my ignorance of the respective ventilators' functions for highly specialized ventilatory modes and their uses for kids/neonates, (which seems to be the specialty of you and many other RRTs that post). I do not often have out-of-the-ordinary modes of ventilation.


Yes I am board certified in peds and neonatel and have worked on PICU/NICU teams in the past but I have as much experience in adult ICU's as PICU/NICU's and I fly probably 70% adults to 30% peds currently.
Dave
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David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT
Program Director and Vice President
AAC - Air Ambulance Caribbean, Inc. D/B/A Flight 4 Life
Charlotte Amalie, St. Thomas, USVI

#10 ST RN/PM

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Posted 04 April 2009 - 09:04 PM

Dave,
Thank you for your responses. Be safe! Steve
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Steve T. RN, PM

#11 SerendepitySaki

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Posted 05 April 2009 - 12:29 AM

Dave,
Thank you for your responses. Be safe! Steve



yeah guys.....AWESOME, OBJECTIVE, INFORMATIVE POSTS.....TRULY ENJOYED!!!!!! thank you so much for taking the time to write in detail...very much appreciated!
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#12 LearRRT-CCEMTP

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Posted 05 April 2009 - 12:30 AM

I forgot to mention that FloridaMedic had a good point about the PEEP and Bilevel NiPPV. What she is talking about is PEEP compensation. I talked indepth about this a year or so ago. Many people don't even take into account whether their vent is PEEP compensated or not and it can cause issues if you don't know. It applies to the modes PCV, PSV, and BiLevel NiPPV. For example the LTV-1000 is not PEEP compensated. Therefore if you have a patient on a compensated hospital BiLevel NiPPV machine with a IPAP of 10 and an EPAP of 5 you would have to set up the LTV-1000 with a PS of 15 and PEEP of 5 to equal the same settings. The same would apply if the patient was on a compensated hospital vent on SIMV/PS or PSV and the PS is 20 and PEEP is 8 you would have to set up the LTV-1000 with a PS of 28 over 8 of PEEP to equal the same settings.

Now unlike the LTV-1000, the LTV-1200 IS PEEP compensated! The lesson to be learned is know your equipment! This is the largest mistake I see transport teams without RRT's make! It can result in you hypoventilating your patients during transports and delivering them in acidotic states!
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#13 FloridaMedic

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Posted 05 April 2009 - 01:51 AM

the PEEP and Bilevel NiPPV. What she is talking about is PEEP compensation. I talked indepth about this a year or so ago. Many people don't even take into account whether their vent is PEEP compensated or not and it can cause issues if you don't know. It applies to the modes PCV, PSV, and BiLevel NiPPV.


The terminology can also get confusing when comparing ventilators especially from ICU to Portable.

BiPAP is a trademarked term from Respironics.

BiLevel is a mode for the ICU ventilator, Puritain Bennett 840 which uses an Active exhalation valve to achieve spontaneous breathing at two different plateau levels or PEEP. It is not to be confused with PSV although the spontaneous breaths can be pressure supported in addition to the two levels of PEEP.

APRV is similar to the BiLevel mode of the PB 840.

Some hospital NIV or NIPPV machines use the terms BiPAP, BiLevel, IPAP, PSV, EPAP, CPAP, PEEP for both modes and settings depending on the make and model of the ventilator.

We also have a new generation of ventiators as well as NIV and NIPPV that have many more modes and breath support features.

Another thing that makes a difference is the internal air compressor and air entrainment system to achieve max inspiratory flow. Some machines decrease flow as FiO2 is increased. This confuses some that are not aware of this and as they increase the FiO2 along with the Rate and/or VT, they may see their patient start to increase in WOB. The patient's condition may have changed requiring more flow but as the settings are increased along with the FiO2, the Peak Inspiratory Flow is not there to meet their demand. They actually had more flow at a lower FiO2. However, the LTV has been the most stable for having a compressor that can keep a fairly consistent flow during FiO2 changes.

To illustrate this, I often use the example of the VentiMask and the NRBM. Paramedics are often taught that the VM is low flow and the NRBM is high flow just based on which one uses the most liter flow. By true definition, the VM is a high flow device because of its ability to entrain air to meet the patient's Peak Inspiratory Flow without restriction even if it doesn't provide a high FiO2. In the hospital we do have VM (Venturi) devices of various sizes to meet the patient's flow demand.

The NRBM, although it can deliver a higher FiO2, is a low flow device. It may not be able to meet PIF demand of the patient as it is running at only 15 L. I have seen too many titrate the liter flow in belief they were titrating the FiO2 without watching the patient's work of breathing. By the time you see the "bag collapsing" thing happening, your patient may be in trouble.
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#14 LearRRT-CCEMTP

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Posted 06 April 2009 - 03:00 PM

The terminology can also get confusing when comparing ventilators especially from ICU to Portable.

BiPAP is a trademarked term from Respironics.

BiLevel is a mode for the ICU ventilator, Puritain Bennett 840 which uses an Active exhalation valve to achieve spontaneous breathing at two different plateau levels or PEEP. It is not to be confused with PSV although the spontaneous breaths can be pressure supported in addition to the two levels of PEEP.

APRV is similar to the BiLevel mode of the PB 840.

Some hospital NIV or NIPPV machines use the terms BiPAP, BiLevel, IPAP, PSV, EPAP, CPAP, PEEP for both modes and settings depending on the make and model of the ventilator.

We also have a new generation of ventiators as well as NIV and NIPPV that have many more modes and breath support features.

Another thing that makes a difference is the internal air compressor and air entrainment system to achieve max inspiratory flow. Some machines decrease flow as FiO2 is increased. This confuses some that are not aware of this and as they increase the FiO2 along with the Rate and/or VT, they may see their patient start to increase in WOB. The patient's condition may have changed requiring more flow but as the settings are increased along with the FiO2, the Peak Inspiratory Flow is not there to meet their demand. They actually had more flow at a lower FiO2. However, the LTV has been the most stable for having a compressor that can keep a fairly consistent flow during FiO2 changes.

To illustrate this, I often use the example of the VentiMask and the NRBM. Paramedics are often taught that the VM is low flow and the NRBM is high flow just based on which one uses the most liter flow. By true definition, the VM is a high flow device because of its ability to entrain air to meet the patient's Peak Inspiratory Flow without restriction even if it doesn't provide a high FiO2. In the hospital we do have VM (Venturi) devices of various sizes to meet the patient's flow demand.

The NRBM, although it can deliver a higher FiO2, is a low flow device. It may not be able to meet PIF demand of the patient as it is running at only 15 L. I have seen too many titrate the liter flow in belief they were titrating the FiO2 without watching the patient's work of breathing. By the time you see the "bag collapsing" thing happening, your patient may be in trouble.


FloridaMedic,
You have such an excellent point. When I first started out we onlu really had Assist-Control, SIMV, PSV, and Pressure Control was still only used for patients with one foot in the grave and you could only find it on a Servo 900-C (Still my favorite vent of all time). Life was simple and most vents utilizes standard these standard names. Now it seems the manifactures try their hardest to come up with new names for the same old modes so they can confuse the world and make their vents look like they have something no one else does! Why as a profession, can Respiratory Practitioners not demand standardized terminology? It would be the safest and most reasonable thing to do! When teaching vent classes to non-RRT's this is one of the hardest things to overcome. At the company I use to work for we had a nurse/medic team pick up a patient on Volume Control. The RN was extremely great with vents but even he was confused and was unsure what this was! He supected it was ACV but was not 100% sure and called me to double check. Life would just be much simplier and I suspect there would be less errors with vents during transport if the Respiratory Care / CCT world would demand standardization!
Be safe,
Dave
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David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT
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Charlotte Amalie, St. Thomas, USVI

#15 Gila

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Posted 06 April 2009 - 05:15 PM

You both are quite correct. Standardization would be safer and easier for non RT providers to understand.
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#16 FloridaMedic

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Posted 07 April 2009 - 01:15 PM

Now it seems the manifactures try their hardest to come up with new names for the same old modes so they can confuse the world and make their vents look like they have something no one else does! Why as a profession, can Respiratory Practitioners not demand standardized terminology? It would be the safest and most reasonable thing to do! When teaching vent classes to non-RRT's this is one of the hardest things to overcome. At the company I use to work for we had a nurse/medic team pick up a patient on Volume Control. The RN was extremely great with vents but even he was confused and was unsure what this was! He supected it was ACV but was not 100% sure and called me to double check. Life would just be much simplier and I suspect there would be less errors with vents during transport if the Respiratory Care / CCT world would demand standardization!
Be safe,
Dave


I do believe the manufacturers should have the option to call the mode however they feel necessary to keep people from saying "it's just the same thing". Often there are some differences in the technology offered by different manufacurers to warrant a variation in terminology. This is like saying if all cars are the same why do some prefer Mercedes and others prefer Ferraris?

Each ventilator may have a different algorithm for the delivery and sensing sequence. The valving may be very different. Puritain Bennett's active exhalation valving sets it apart from others. Its BiLevel mode in no were near a BiPAP or other two level mode. It is similar but different from traditional PCV and although some try to describe it as a form if Inverse I:E ratio ventilation, it has very different characteristics that allows pressure supported breaths. The software programs are also different for ventilators that offer a volume guarantee in a spontaneous mod which is sorta like PSV but different.

Thus, the different terminology should be an indication that one must know their machine and not take it for granted that all is the same. That is where many fail in their education of ventilation/oxygenation. Non RT vent programs just teach "modes" without a lot of the informaton about the delivery of those modes. Dave, if you remember in RT school we learned about the hardware or internal machinery/workings of the various ventilators first as if we were engineers or mechanics long before we got into modes and applications. Once we understood how the machines worked, we could understand flow inititation and termination.

Too often when moving a patient from one vent to another, some just match numbers and "modes" without understanding the delivery features of that machine. Or, when they do look at the PIP, they don't see that the ICU machine is using a presssure/flow algorithm sequencing to determine breath to breath flow determination rather than a fixed amount. The graphics speak volumes about this. Often if I have left to use less then good transport technology, I will look at the MAP and graphics of the other ventilator to see how I can adapt my machine to achieve something similar which may be totally different mode and numbers than on the other ventilator. This is a problem often encountered when coming off of a really good ICU machine running APRV, BiLevel or HFV of some type to a transport machine for either an inter or intra-facility transport.
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