Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study

Itagaki, Taiga; Bennett, Desmond J; Chenelle, Christopher T; Fisher, Daniel F.; Kacmarek, Robert M.

doi:10.4187/respcare.05012

Cited by 19 publications

(20 citation statements)

References 42 publications

(76 reference statements)

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“…Regarding the ventilators employed to deliver bilevel NIV, we have found some variability. Several bench studies have been published analyzing capabilities of different devices, and results differ according to the model (adult or neonatal) used . Unfortunately, there are no specific RCTs analyzing ventilators or ventilator‐interface effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Non‐invasive ventilation practices in children across Europe

Mayordomo-Colunga

Pons-Òdena²,

Medina

et al. 2018

Pediatric Pulmonology

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Section: Discussionmentioning

confidence: 99%

Non‐invasive ventilation practices in children across Europe

Mayordomo-Colunga

Pons-Òdena²,

Medina

et al. 2018

Pediatric Pulmonology

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“…The ability to provide consistent and accurate V T and triggering has recently been evaluated across different volume-targeted modes and ventilator brands by using neonatal lung simulators with simulated ETT leaks. 4 However, there is a lack of data from human and animal studies to indicate whether volume-targeted mode performance of different ventilator brands has any effect on physiologic outcomes. We hypothesized that there would be no differences in ventilation parameters, gas exchange, triggering, or effort of breathing in surfactant-deficient, lung-injured, spontaneously breathing juvenile rabbits with and without an ETT leak among 3 different volume-targeted modes that monitor V T at different locations and regulate PIP based on inspiratory, expiratory, or leak adapted (compensated) V T .…”

Section: See the Related Editorial On Page 484mentioning

confidence: 99%

Physiologic Effects of 3 Different Neonatal Volume-Targeted Ventilation Modes in Surfactant-Deficient Juvenile Rabbits

et al. 2019

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BACKGROUND: Different brands of volume-targeted modes may vary the location of tidal volume (V T ) monitoring and whether peak inspiratory pressure is adjusted based on inspiratory, expiratory , or leak-compensated V T . These variables may result in different levels of support provided to patients, especially when an endotracheal tube (ETT) leak is present. We hypothesized that there would be no differences in gas exchange, triggering, or work of breathing between volume-targeted modes of 3 different brands of equipment in a surfactant-deficient, spontaneously breathing animal model with and without an ETT leak. METHODS: Twelve rabbits (mean ؎ SD 1.61 ؎ 0.20 kg) were sedated, anesthetized, intubated, lavaged with 0.9% saline solution, and randomized in a crossover design so that each animal was supported by 3 different volume-targeted modes at identical settings with and without an ETT leak. After 30 min, arterial blood gas, V T , and esophageal and airway pressure were recorded for each condition, and pressure-rate product and percentage of successfully triggered breaths were calculated. RESULTS: Gas exchange and the pressure-rate product were not different between the ventilators in the absence of an ETT leak. When an ETT leak was introduced, volume-guarantee modes allowed a higher percentage of triggered breaths and peak inspiratory pressure, which resulted in higher minute ventilation, pH, and lower P aCO 2 than the pressure-regulated volume control mode (P < .05). CONCLUSIONS: When a moderate ETT leak was present, volume-targeted modes that used proximal V T monitoring and triggering with adaptive leak compensation capabilities appeared more effective in providing ventilation support than did a ventilator that used measurements obtained from the back at the ventilator and does not have leak compensation.

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“…Recent studies have shown that, even if compensation algorithms can markedly reduce measurement errors, overall performance are not yet ideal [16, 27] and improvements are still needed, especially during variable leaks [28]. …”

Section: The Mechanical Ventilator: the Challenge Of Delivering Accurmentioning

confidence: 99%

Trends in mechanical ventilation: are we ventilating our patients in the best possible way?

Dellacà

Veneroni

Farré

2017

Breathe

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This review addresses how the combination of physiology, medicine and engineering principles contributed to the development and advancement of mechanical ventilation, emphasising the most urgent needs for improvement and the most promising directions of future development.Several aspects of mechanical ventilation are introduced, highlighting on one side the importance of interdisciplinary research for further development and, on the other, the importance of training physicians sufficiently on the technological aspects of modern devices to exploit properly the great complexity and potentials of this treatment.Educational aimsTo learn how mechanical ventilation developed in recent decades and to provide a better understanding of the actual technology and practice.To learn how and why interdisciplinary research and competences are necessary for providing the best ventilation treatment to patients.To understand which are the most relevant technical limitations in modern mechanical ventilators that can affect their performance in delivery of the treatment.To better understand and classify ventilation modes.To learn the classification, benefits, drawbacks and future perspectives of automatic ventilation tailoring algorithms.

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Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study

Abstract: The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted V. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.

Cited by 19 publications

References 42 publications

Non‐invasive ventilation practices in children across Europe

Non‐invasive ventilation practices in children across Europe

Physiologic Effects of 3 Different Neonatal Volume-Targeted Ventilation Modes in Surfactant-Deficient Juvenile Rabbits

Trends in mechanical ventilation: are we ventilating our patients in the best possible way?

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