A Bench Evaluation of Eight Home-Care Ventilators

Abstract

BACKGROUND:The growing number of patients on home mechanical ventilation has driven considerable progress in the performance and functionality of ventilators, with features comparable with those used in the ICU. However, a publication gap exists in the evaluation and comparison of their performance and each ventilator choice depends on machine characteristics defined by manufacturers. METHODS: We bench tested 8 home-care ventilators that are currently available: Monnal T50, EOVE EO-150, Puritan Bennet 560, Weinmann, PrismaVent 50, Trilogy Evo, Astral 150, and Vivo 60 by using an active lung model. These devices were tested under 18 experimental conditions that combined 3 variables: respiratory mechanics, ventilatory mode, and inspiratory muscle effort. The volume delivered, trigger response, pressurization capacity, and synchronization were analyzed. RESULTS: Significant differences were observed in the performance among the devices. Decreased inspiratory muscle effort caused changes in the delivered volume, which worsened the response-to-trigger time, pressurization capacity, and synchronization. Increased pressure support favored the development of asynchronies. All the ventilators developed asynchronies under at least 1 set of conditions, but the EOVE and Trilogy Evo ventilators showed the fewest asynchronies during the experimental conditions studied. CONCLUSIONS: Great variability in terms of technical performance was observed among the 8 home-care ventilators analyzed. Asynchronies became a major issue when home mechanical ventilation was used under higher pressure-support values and lower muscle efforts. Our results may prove to be useful in helping choose the best suited machine based on a patient's clinical therapy needs.

Are all ventilators for NIV performing the same? A bench analysis

“…This study explored general performance of six ventilators using the ASL5000 © lung simulator, validated in previous analysis [8,9,35,36]. They were tested during NIV against different combinations of mechanical pattern, ventilatory mode, leak level and inspiratory effort, with similar methodology as our previous work [32]. Measured results included volume delivered, time response to trigger, pressurization capacity and synchronization.…”

“…It is interesting to evaluate TDT during PSV (Table 3) and pay special attention in obstructive mechanical pattern, as TDT is directly related to comfort during NIV, especially at home, and numerous users of home-care ventilators are patients with obstructive pathology. Values higher than 200 ms have been described as clinical limit related to dyspnea [26,32]. Table 3 also includes trigger sensitivity adjustment for each ventilator, as it directly influences TDT results.…”

“…Pressure values were taken from the beginning of any detected inspiratory effort and up to 0.5 s. At 20 breaths per minute (and I:E 1:2),a time-span of 0.5 s from the beginning of inspiratory effort is 50% of the inspiratory time. We considered that during this time the pressure delivered to the patient should be at least 50% of the ideal pressurization, based on previous publications [32,33] and our clinical experience, so good pressurization capacity for NIV devices should show PTP500 values over 50%.…”

From bedside to bench - In vivo and in vitro evaluation of mechanically assisted cough treatment in a patient with bulbar Amyotrophic Lateral Sclerosis

“…Bench studies have explored ventilator waveforms [ 12 ], but this has not been done to the same extent for MI-E devices. Such evaluations may provide clinically relevant information.…”

Mask interfaces and devices for home noninvasive ventilation in children

“…12,47 Therefore, the choice of the device will be based on its capacity to detect the patient's inspiratory flows, 39 and particularly for "weak" patients such as infants or young children with neuromuscular diseases. 9,47,48 Indeed, patient-ventilator asynchrony, such as trigger and cycling asynchronies, or ineffective efforts, can result either because of inappropriate settings or major leaks, but also in case of an inadequate device. 14,49,50 The clinical consequences of patient-ventilator asynchrony may concern sleep disruption, comfort, NIV efficiency, and nocturnal gas exchange, but require further investigation.…”