A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study

Oto, Jun; Chenelle, Christopher T; Marchese, Andrew D.; Kacmarek, Robert M.

doi:10.4187/respcare.02466

Cited by 52 publications

(55 citation statements)

References 20 publications

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“…The frequency of auto-triggering depends on the ventilator performance, as described in previous studies. 13,14,17,20 Auto-triggering was less frequent in the obstructive model than the normal or restrictive models, and this concurs with previous reports. [21][22][23] Most acute care ventilators have cycling systems based on a preset flow threshold.…”

Section: Discussionsupporting

confidence: 82%

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A Comparison of Leak Compensation During Pediatric Noninvasive Ventilation: A Lung Model Study

et al. 2013

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BACKGROUND: Ventilators used for noninvasive ventilation (NIV) must be able to synchronize in the presence of system leaks. We compared the ability of 7 ICU ventilators and 3 dedicated NIV ventilators to compensate for leaks during pediatric NIV. METHODS: Using a lung simulator, we compared the Maquet Servo-i, Dräger V500, Dräger Carina, Covidien PB840, Respironics V60, Respironics Vision, GE Healthcare/Engström Carestation, CareFusion Avea, Hamilton C3, and Hamilton G5 during increasing (n ‫؍‬ 6) and decreasing leaks (n ‫؍‬ 6). With a lung simulator we tested 4 leak levels (baseline [BL] 2-3 L/min, L1 5-6 L/min, L2 9 -10 L/min, and L3 19 -20 L/min); 3 patient weights (10, 20, and 30 kg); and 3 lung mechanics scenarios (normal, obstructive, and restrictive). The ventilator settings were NIV mode, pressure support of 10 cm H 2 O, and PEEP of 5 cm H 2 O. The synchronization rate (synchronized cycles/total simulated respirations) was recorded for each ventilator and each leak scenario. Synchronization was defined as triggering without auto-triggering, miss-triggering, delayed cycling, or premature cycling. RESULTS: The mean synchronization rate across all ventilators was 68 ؎ 27% (range 23-96%) and marked differences existed between the ventilators (P < .001). Significant differences in synchronization rate were observed between the 10-kg model (mean 57 ؎ 30%, range 17-93%), the 20-kg model (69 ؎ 30%, 25-98%), and the 30-kg models (77 ؎ 22%, 28 -97%) (P < .001). The synchronization rate for the obstructive model (60 ؎ 30%, 9 -94%) was significantly different from the normal model (71 ؎ 29%, 18 -98%) and the restrictive model (72 ؎ 28%, 23-98%) (P < .001). The PB840 and the C3 had synchronization rates over 90% overall across all body weights, all lung mechanic profiles, and all leak levels. CONCLUSIONS: Leak compensation in NIV for pediatric use can partially compensate for leaks, but varies widely among ventilators, patient weights, and lung mechanics.

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Section: Discussionsupporting

confidence: 82%

“…The lung simulator was used to simulate 3 pediatric ventilation scenarios, with different lung sizes based on weight (10,20, and 30 kg) (Fig. 1).…”

Section: Study Setupmentioning

confidence: 99%

A Comparison of Leak Compensation During Pediatric Noninvasive Ventilation: A Lung Model Study

et al. 2013

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“…13 This modality has been proved to be reliable in situations of constant ventilator load, 14,15 but its efficacy may be affected by changes in the characteristics of the respiratory system and by the presence of leaks. [15][16][17][18] The specificities of MPV, such as the intermittent disconnection of the patient and the presence of continuous leaks, may thus represent a challenge for turbine-based home ventilators. In the last few years, some ventilator manufacturers have integrated several improvements for MPV in their software, or even a dedicated ventilation modality to deal with the particularities of MPV, but we are unaware of any studies investigating the usefulness of these technical advances.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation

et al. 2016

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The aim of our study was to evaluate efficacy and reliability of currently available ventilators for mouthpiece ventilation (MPV). Five life-support home ventilators were assessed in a bench test using different settings simulating the specificities of MPV, such as intermittent circuit disconnection and presence of continuous leaks. The intermittent disconnection of the circuit caused relevant swings in the delivered tidal volume (V T ), showing a V T overshoot during the disconnection periods and a V T decrease when the interface was reconnected to the test lung. The five ventilators showed substantial differences in the number of respiratory cycles necessary to reach a stable V T in the volume-controlled setting, ranging from 1.3 + 0.6 to 7.3 + 1.2 cycles. These differences were less accentuated in the volume-assisted setting (MPV-dedicated mode, when available). Our data show large differences in the capacity of the different ventilators to deal with the rapidly changing respiratory load features that characterize MPV, which can be further accentuated according to the used ventilator setting. The dedicated MPV modes allow improvement in the performance of ventilators only in some defined situations. This has practical consequences for the choice of the ventilator to be used for MPV in a specific patient.

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“…10 In this very interesting bench study, Oto et al simulated ARDS and COPD conditions and used a very realistic lung simulator and manikin setup, and elaborated increasing and decreasing leakage scenarios to assess the ability of 7 ICU ventilators and of 1 NIV-dedicated ventilator to prevent triggering and cycling asynchrony caused by varying leaks during both invasive and noninvasive ventilation. They also recorded the number of breaths required to obtain acceptable synchrony when leak was changed, which is a very original approach.…”

mentioning

confidence: 99%

Varying Leaks: A Challenge for Modern Ventilators?

Vignaux

Piquilloud

2013

Respir Care

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A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Model Study

Cited by 52 publications

References 20 publications

A Comparison of Leak Compensation During Pediatric Noninvasive Ventilation: A Lung Model Study

A Comparison of Leak Compensation During Pediatric Noninvasive Ventilation: A Lung Model Study

Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation

Varying Leaks: A Challenge for Modern Ventilators?

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