Category: News

2021 Baltimore Magazine Top Docs!

Top Doctors Magazine

PCCAB physicians are recognized by their peers as Baltimore Magazine’s “Top Doctors”.

Congratulations to our physicians who are leaders in pulmonary, critical care and sleep medicine.

Critical Care Medicine

Madhat Arnouk
Linda Barr
Jason Birnbaum

Pulmonary

Linda Barr
Jason Birnbaum
Hasan Shakoor

Sleep Medicine

Brian Bohner

The full selection methodology and complete list of “Top Docs” is available in the November 2021 issue of Baltimore magazine.

To our CPAP Patients:

On Monday June 14, Philips Respironics issued a voluntary recall on nearly all of its CPAP and BiPAP machines- including Dreamstation1. A small percentage of machines have been confirmed to have a defect resulting in damage to an insulating foam within the blower unit. It appears that this has been found predominantly when such machines have been cleaned with ozone cleaning machine device.

The defective machines may emit small black particles that are pieces of foam, and these may be seen in your water chamber or tubing. Symptoms can include new development of headache, dizziness, sinus congestion, or chest pressure after usage of the device.

Click on www.Philips.com/src-update for Philips Respironics announcement.

Many of you have received the notice from the manufacturer to discontinue use of the machine until contacting your physician. Our physicians have had many meetings with the manufacturer as well as with other sleep medicine practices, and we currently recommend the following:

  • Call Philips Respironics at 1-877-907-7508 to register your device or register your device via the web at: https://www.philipssrcupdate.expertinquiry.com/
  • Even if your device is indeed on the Philips Respironics recall list, we do NOT recommend discontinuing the use of your PAP therapy, but to contact Philips Respironics for follow up of repair or replacement of the device.
  • If you suspect your machine is not simply on the recall list, but actually defective based upon black particles visible to the naked eye in your tubing or water chamber, you should contact your equipment company to see if more timely corrective measures can be offered, such as a new or borrowed machine.
  • For machines that are either on recall or actually defective, the repair involves removing and replacing the foam that is embedded inside the machine. This can only be done by the manufacturer, not by your DME supplier.
  • Finally, although we do not recommend discontinuing the use of your machine, we do recommend that all of our patients discontinue the use of ozone or UV cleaners until we have learned more about this. Just use soap and water or a vinegar solution for now.

Please understand that our office staff and physicians do not have any further information, or access to actual equipment. Please check with Philips Respironics and your DME company for further information.

We are looking forward for prompt intervention from the manufacturer to ensure that the device is repaired or replaced. We will be posting updates on this site as we receive them from the manufacturer.

The physicians and staff of PCCAB

 

Frequently asked questions

1. Why is Philips issuing a recall notification for certain CPAP, BiLevel PAP and mechanical ventilators?

  • On April 26, 2021, Philips provided an important update regarding proactive efforts to address identified issues with a component in certain products of our Sleep and Respiratory Care portfolio.
  • At that time, out of an abundance of caution and based on available information, Philips advised of potential health risks related to sound abatement foam used in specific Philips Continuous Positive Airway Pressure (CPAP), BiLevel Positive Airway Pressure (BiLevel PAP) devices, and Mechanical Ventilators. The company also indicated that analysis of potential health risks was ongoing, and that further information would be provided when available.
  • As a result of extensive ongoing analysis following this announcement, on June 14, 2021, the company issued a recall notification for specific affected devices.
  • The recall notification informs customers and users of potential impacts on patient health and clinical use related to this issue. Possible health risks include exposure to degraded sound abatement foam, for example caused by unapproved cleaning methods such as ozone, and exposure to chemical emissions from the foam material. High heat and high humidity environments may also contribute to foam degradation in certain regions.
  • To date, Philips has received a limited number of reports of possible patient impact due to foam degradation, and no reports to date regarding patient impact related to chemical emissions. The company continues to monitor reports of potential safety issues as required by medical device regulations and laws in the markets in which we operate.
  • The recall notification advises patients and customers to take the following actions:
    • For patients using BiLevel PAP and CPAP devices: Discontinue use of affected units and consult with physicians to determine the benefits of continuing therapy and potential risks.
    • For patients using life-sustaining mechanical ventilator devices: DO NOT discontinue or alter prescribed therapy, without consulting physicians to determine appropriate next steps.
  • Philips is recommending that customers and patients halt use of ozone-related cleaning products, and adhere to their device Instructions for Use for approved cleaning methods.
  • Additionally, Philips is reminding customers and patients to review the age of their BiLevel PAP and CPAP devices, as they are typically recommended to be replaced after five years of use.
  • We are treating this matter with the highest possible seriousness, and are working to address this issue as efficiently and thoroughly as possible.
  • The company has developed a comprehensive plan to replace the current sound abatement foam with a new material that is not affected by this issue, and has already begun this process.
  • For more information on the recall notification, as well as instructions for customers, users and physicians, affected parties may contact their local Philips representative or visit philips.com/SRC-update. In the US, affected parties may also call, toll free, 877-907-7508.

2. What devices are affected by the recall notification?

  • The recall notification provides customers with information on how to identify affected products.
  • Additionally, the device Instructions for Use provide product identification information to assist with this activity.
  • Products affected by this recall notification include:

CPAP and BiLevel PAP Devices

All Affected Devices Manufactured Before 26 April 2021, All Device Serial Numbers

Continuous Ventilator, Minimum Ventilatory
Support, Facility Use

E30 (Emergency Use Authorization)

Continuous Ventilator, Non-life Supporting DreamStation ASV

DreamStation ST, AVAPS
SystemOne ASV4
C-Series ASV
C-Series S/T and AVAPS
OmniLab Advanced+

Noncontinuous Ventilator SystemOne (Q-Series)

DreamStation
DreamStation Go
Dorma 400
Dorma 500
REMstar SE Auto

 

Mechanical Ventilators

All Affected Devices Manufactured Before 26 April 2021, All Device Serial Numbers

Continuous Ventilator 

Trilogy 100
Trilogy 200
Garbin Plus, Aeris, LifeVent

Continuous Ventilator, Minimum Ventilatory
Support, Facility Use

A-Series BiPAP Hybrid A30
(not marketed in the US)
A-Series BiPAP V30 Auto

Continuous Ventilator, Non-life Supporting

A-Series BiPAP A40
(not marketed in the US)
A-Series BiPAP A30
(not marketed in the US)

3. What products are not affected and why?

  • Products that are not affected may have different sound abatement foam materials, as new materials and technologies are available over time. Also, sound abatement foam in unaffected devices may be placed in a different location due to device design.
  • Products not affected by this recall notification include:
    1. Trilogy Evo
    2. Trilogy Evo OBM
    3. EV300
    4. Trilogy 202
    5. A-Series Pro and EFL
    6. M-Series
    7. DreamStation 2
    8. Omnilab (original based on Harmony 2)
    9. Dorma 100, Dorma 200, & REMstar SE
    10. All oxygen concentrators, respiratory drug delivery products, airway
    clearance products.

4. Are affected devices safe for use? Should affected devices be removed from service?

  • The recall notification advises patients and customers to take the following actions:
    • For patients using BiLevel PAP and CPAP devices: Discontinue use of affected units and consult with physicians to determine the benefits of continuing therapy and potential risks.
    • For patients using life-sustaining mechanical ventilator devices: DO NOT discontinue or alter prescribed therapy, without consulting physicians to determine appropriate next steps.
  • Philips is recommending that customers and patients halt use of ozone-related cleaning products, and adhere to their device Instructions for Use for approved cleaning methods.
  • Additionally, Philips is reminding customers and patients to review the age of their BiLevel PAP and CPAP devices, as they are typically recommended to be replaced after five years of use.

5. What is the safety hazard associated with this issue? Has Philips received any reports of patient harm due to this issue?

  • The recall notification informs customers and users of potential impacts on patient health and clinical use related to this issue. Possible health risks include exposure to degraded sound abatement foam, for example caused by unapproved cleaning methods such as ozone, and exposure to chemical emissions from the foam material. High heat and high humidity environments may also contribute to foam degradation in certain regions.
    Philips continues to monitor reports of potential safety issues through our postmarket surveillance activities as required by medical device regulations and laws in the markets in which we operate.

In the event of exposure to degraded foam:

  • The potential risks of degraded foam exposure include:
    • Irritation (skin, eye, and respiratory tract), inflammatory response, headache, asthma, adverse effects to other organs (e.g. kidneys and liver) and toxic carcinogenic effects.
  • To date, Philips Respironics has received several complaints regarding the presence of black debris/particles within the airpath circuit (extending from the device outlet, humidifier, tubing, and mask). Philips also has received reports of headache, upper airway irritation, cough, chest pressure and sinus infection.

In the event of exposure to chemical emissions:

  • The potential risks of exposure due to chemical emissions from affected foam include: headache/dizziness, irritation (eyes, nose, respiratory tract, skin), hypersensitivity, nausea/vomiting, toxic and carcinogenic effects.
  • To date, Philips has not received reports of patient impact or serious harm as a
    result of this issue.

6. When will the correction for this issue begin? How long will it take to address all affected devices?

  • Philips is notifying regulatory agencies in the regions and countries where affected products are available.
  • We are providing agencies with required information related to the initial launch and ongoing implementation of the projected correction.
  • The company will replace the current sound abatement foam with a new material that is not affected by this issue, and has already begun this process.
  • At this time, the company is working to address all affected devices within the scope of this correction as expeditiously as possible.

7. Are affected devices continuing to be manufactured and/or shipped?

  • At this time, affected devices are on manufacturing and ship hold as the company prepares to implement the repair / replacement program for affected devices, to install new sound abatement foam material not affected by the reported issues.

8. Is this a recall? Have regulatory authorities classified the severity of the recall?

  • The issuance of the recall notification is a recall according to regulatory agency criteria.
  • This recall notification has not yet been classified by regulatory agencies.

9. How will Philips address this issue? Are affected devices being replaced and/or repaired? Are customers entitled to warranty replacement, repair, service or other mitigations?

  • We are treating this matter with the highest possible seriousness, and are working to address this issue as efficiently and thoroughly as possible.
  • As a result of extensive ongoing analysis, on June 14, 2021, the company issued a recall notification for specific affected Continuous Positive Airway Pressure (CPAP), BiLevel Positive Airway Pressure (BiLevel PAP) devices, and Mechanical Ventilators.
  • The recall notification informs customers and users of potential impacts on patient health and clinical use related to this issue. Possible health risks include exposure to degraded sound abatement foam, for example caused by unapproved cleaning methods such as ozone, and exposure to chemical emissions from the foam material.
  • Philips is notifying customers and users of affected devices that the company will replace the current sound abatement foam with a new material that is not affected by this issue. Affected devices currently will be either replaced with a new or refurbished unit that incorporates the new material, or repaired to replace the sound abatement foam in customer units. The new material will also replace the current sound abatement foam in future products.
  • Philips is recommending that customers and patients halt use of ozone-related cleaning products, and adhere to their device Instructions for Use for approved cleaning methods.
  • Additionally, Philips is reminding customers and patients to review the age of their BiLevel PAP and CPAP devices, as they are typically recommended to be replaced after five years of use.
  • The company has dedicated significant resources to address this issue, and has developed a comprehensive plan for this correction, and has already begun this process. This effort includes wide-scale, global ramping up of manufacturing, repair, services, supply chain and other functions to support the correction.
  • Philips deeply regrets the inconveniences caused by this issue, and we are dedicating significant time and resources to give affected patients and customers the service they expect and deserve as we resolve this matter as our top priority.
  • For more information on the recall notification, as well as instructions for customers,
    users and physicians, affected parties may contact their local Philips representative or
    visit philips.com/SRC-update. In the US, affected parties may also call, toll free,
    877-907-7508.

10. Are there any steps that customers, patients, users and/or clinicians should take regarding this issue?

  • Customers, patients, users and clinicians are instructed to follow the guidance
    contained in the recall notification.
  • The recall notification advises patients and customers to take the following actions:
    • For patients using BiLevel PAP and CPAP devices: Discontinue use of affected units and consult with physicians to determine the benefits of continuing therapy and potential risks.
    • For patients using life-sustaining mechanical ventilator devices: DO NOT discontinue or alter prescribed therapy, without consulting physicians to determine appropriate next steps.
    • Register affected devices on the recall website, philips.com/SRC-update.
      • The website provides current information on the status of the recall and how to receive permanent corrective action to address the two issues.
      • The website also provides instructions on how to locate an affected device Serial Number and will guide users through the registration process.
      • In the US, call 877-907-7508 Service Hotline if you cannot visit the website or do not have internet access.
  • The company has developed a comprehensive plan for this correction, and has already begun this process.
  • Philips is recommending that customers and patients halt use of ozone-related cleaning products, and adhere to their device Instructions for Use for approved cleaning methods.
  • Additionally, Philips is reminding customers and patients to review the age of their BiLevel PAP and CPAP devices, as they are typically recommended to be replaced after five years of use.
  • Philips deeply regrets the inconveniences caused by this issue, and we are dedicating significant time and resources to give affected patients and customers the service they expect and deserve as we resolve this matter as our top priority.
  • For more information on the recall notification, as well as instructions for customers, users and physicians, affected parties may contact their local Philips representative or visit philips.com/SRC-update. In the US, affected parties may also call, toll free, 877-907-7508.

11. What is the cause of this issue? Was it a design, manufacture, supplier or other problem?

  • Based on Philips analysis, the root cause of this issue is related to the sound abatement foam currently used in specific identified products of the Sleep and Respiratory Care portfolio.

12. How did this happen, and what is Philips doing to ensure it will not happen again?

  • Philips has a robust Quality Management System and has followed our review and
    analysis processes to help identify and address this issue.
  • The products were designed according to, and in compliance with, appropriate standards upon release. As new standards are developed, they require assessment of product characteristics according to quality and regulatory processes. Philips Quality Management System has been updated to reflect these new requirements.
  • However, while standards have been updated, products developed on the prior standard are still in compliance with medical device regulations. The foam degradation and chemical emission issues were discovered as part of our Quality Management System processes, and are being corrected in accordance with appropriate regulatory requirements.
  • Philips has been in full compliance with relevant standards upon product commercialization.

13. What is meant by “high heat and humidity” being one of the causes of this issue?

  • Philips has determined that the foam may degrade under certain circumstances, influenced by factors including use of unapproved cleaning methods, such as ozone*, and certain environmental conditions involving high humidity and temperature.
  • The environmental conditions that may be one of the causes of this issue refer to the
    climate and regional temperatures of the countries where the devices are used
    and stored.
  • This factor does not refer to heat and humidity generated by the device for patient use.

14. Do affected units exhibit features that customers / users should watch out for? Particles or other visible issues?

  • Users should consult with their physicians as directed in the recall notification.

15. Can Philips replace products under warranty or repair devices under warranty?

  • Affected devices may be repaired under warranty.
  • Philips will provide further information regarding warranty replacement procedures during this issue when it is available.

16. In those regions where Philips provides both patient care and devices, will new patients be set up with devices? Will existing patient devices that fail be replaced?

  • At this time, Philips is unable to set up new patients on affected devices. Philips may
    work with new patients to provide potential alternate devices.
  • Philips may repair / replace ventilator units that patients are reliant on in emergency
    situations such as device failure during required treatment, to ensure continuity of care.
  • Philips CPAPs cannot be replaced during ship hold.

17. Is Philips certain that this issue is limited to the listed devices? Is there any possibility others are affected?

  • Philips has completed our analysis in accordance with our Quality Management System and identified all affected products, which are included in our notifications to regulatory agencies and customers.
  • No further products are affected by this issue.

 

Dr. Madhat Arnouk joins PCCAB Towson

Multi physician uses specialized knowledge of pulmonary, critical care and sleep medicine to treat patients comprehensively.

We are thrilled to welcome talented pulmonologist, critical care physician and sleep medicine specialist Dr. Madhat Arnouk to the Pulmonary and Critical Care Associates of Baltimore. He will practice out of our Towson location.

Dr. Anouk is a board-certified physician specializing in critical care, pulmonary diseases and sleep medicine. His training in multiple specialties gives him a broad approach to patient care which results in improved outcomes. Dr. Arnouk says the opportunity to provide multi-pronged care made the PCCAB position even more attractive.

“The mix of inpatient and outpatient treatment in multiple specialties strengthens opportunities for positive patient outcomes,” said Dr. Arnouk. “It keeps our physicians at the top of our fields, enabling us to provide the best patient care.”

Dr. Arnouk is skilled in the diagnosis and treatment of obstructive lung disease, sleep apnea, acute lung injuries and sepsis, as well as early screening and diagnosis for lung cancer. He works closely with patients to understand their expectations and goals, keeping them informed by sharing step-by-step results and options.

“It’s incredibly rewarding to help patients overcome injury and illness,” said Dr. Arnouk. “There’s nothing I love more than seeing my patients reach good health.”

Dr. Arnouk was previously the associate director of the Sleep and Breathing Disorders Center in Brooklyn, New York. He completed his fellowship in sleep medicine at the University of Buffalo, and his fellowship in pulmonary and critical care medicine at the State University of New York Downstate Medical Center. He performed cancer and pulmonary research at the Roswell Park Comprehensive Cancer Center, where he focused on lung cancer.

To schedule an appointment with Dr. Arnouk, click here or call 410-494-1662.

PCCAB physicians named among Baltimore’s “Top Docs”

The latest Baltimore magazine list of “Top Docs” recognizes physicians from the Pulmonary and Critical Care Associates of Baltimore (PCCAB) as leading their specialties. Six of the seven pulmonologists named “Top Docs” are PCCAB practitioners, as are two of the three sleep medicine specialists and six of the twelve critical care physicians.

In all, nine PCCAB physicians are recognized as being the best in their fields. Drs. Linda Barr, Jason Birnbaum, George Pyrgos, Salim Rizk, Hasan Shakoor and Dr. Peter Sloane are recognized as the top pulmonologists in the region. Drs. Barr, Birnbaum, Pyrgos, Rizk and Shakoor are also recognized as the best intensivists in Baltimore, alongside Dr. Mitchell Schwartz. Drs. Brian Bohner and Jacques Conaway are recognized as the top sleep medicine physicians.

“Our physicians are deeply committed to providing the highest-quality patient care,” said Brian Bohner, Managing Partner of PCCAB. “We are proud to see their expertise recognized by Baltimore magazine and peer physicians from across the region.”

Just five percent of doctors in Greater Baltimore are named “Top Docs”. The listing culminates a nine-month selection process in which thousands of physicians are polled to determine which doctors are the best of the best in each specialty. The process is overseen by Baltimore magazine in conjunction with three independent physician advisors.

PCCAB practitioners are frequent honorees on the list. Drs. Birnbaum, Bohner, Conaway, Pyrgos, Rizk, Schwartz and Sloane have all been recognized in previous “Top Docs” listings, as has PCCAB pulmonologist Dr. Buescher.

The full selection methodology and complete list of “Top Docs” is available in the November 2018 issue of Baltimore magazine.

5 Ways to Get Better Sleep

Looking to improve your health, enhance productivity at work, and achieve personal goals? Sleep is the key. It may sound too simple, but getting seven to eight hours of sleep a night can improve your mood and protect you from health issues like heart disease and obesity. In honor of Sleep Awareness Week, leading PCCAB sleep physicians share five ways to improve your sleep health:

Make a plan

It’s common to schedule dates, workouts, and even phone calls—why not schedule sleep? Bedtime calculators, like the one offered by the National Sleep Foundation, can help you reverse-engineer your sleep schedule based on when you need to wake up. When you plan for healthy sleep, you’re more likely to stick to it.

Set the mood

Creating a bedtime ritual can signal to your brain that it’s time to slow down. Things like turning down the lights and reducing screen time in the hour before bed can help set the stage for a good night’s sleep. Scheduling the “do not disturb” function on your phone for bedtime hours can further reduce distractions and keep you in the right state of mind.

Put your data to use

Most modern fitness trackers report your sleep data, but do you know what it means? Assess your data to determine whether you’re meeting the National Sleep Foundation guidelines for quality sleep. You should be:   

  • Falling asleep in 30 minutes or less 
  • Waking up no more than once per night 
  • Awake for less than 20 minutes after initially falling asleep; and
  • Getting seven to eight hours of total sleep, with 85 percent of sleep occurring in bed

If you’re falling outside the guidelines for one or more of these areas, take action to get back on track. For example, if you’re waking at night, there are a range of free meditation apps that can help ease you back into restful sleep. InsightTimer and Calm are good starting points.

Use naps to fill in the gaps

If getting the recommended seven to eight hours of sleep a night isn’t possible for you, naps are a good replacement. Studies show that taking a short morning & afternoon nap can reduce stress and limit the effects of sleep deprivation. Aim to nap for 20 to 30 minutes twice a day.

See a professional

If you’re following the steps above and still not getting the sleep you need, it’s time to see a professional. The board certified physicians at PCCAB provide consultative services, sleep studies, post-study review and CPAP therapy services to help you get your sleep back on track. PCCAB physicians are dedicated to providing compassionate and personalized care. Request an appointment online or contact one of our locations today to make an appointment.

 

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