Potential Rebreathing After Continuous Positive Airway Pressure Failure During Sleep

Farré, Ramón; Montserrat, Josep M.; Ballester, Eugeni; Navajas, Daniel

doi:10.1378/chest.121.1.196

Cited by 13 publications

(5 citation statements)

References 4 publications

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“…), which play an important role in the success of HMV, are not defined [18]. Indeed, some limitations and risks of currently available home ventilators have been reported [19][20][21][22][23][24][25]. It should be mentioned that the results of the quality-control survey indicate that, in several countries, the provider can change the ventilator type without prescriber agreement.…”

Section: Discussionmentioning

confidence: 99%

Quality control of equipment in home mechanical ventilation: a European survey

Farré¹

2005

Eur Respir J

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Quality control of the equipment used in home mechanical ventilation is necessary in order to ensure that patients safely and accurately receive the prescribed ventilatory support. The aim of this study was to carry out a survey on the quality-control procedures in different centres and countries.The survey was carried out in the context of a European Commission Concerted Action covering 16 European countries. The study was extensive and detailed, involving 326 centres, which provided home ventilation to .20,000 patients.The survey showed that: 1) ventilator servicing was mainly carried out by external companies (62% of centres), with a servicing frequency ranging 3-12 months; 2) interaction between servicing companies and prescribers was limited (only 61% of centres were always informed of major incidents); 3) participation of centres in equipment quality control was poor (only 56% of centres assessed that patients/caregivers correctly cleaned/maintained the ventilator); and 4) centres were insufficiently aware of vigilance systems (only 23% of centres). Moreover, the data showed considerable inter-and intra-country differences. The size of the centre was an important determinant of many of these quality-control aspects.This survey provides information that will enable the European Commission Concerted Action to formulate recommendations on procedures for home-ventilator quality control.

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Section: Discussionmentioning

confidence: 99%

Quality control of equipment in home mechanical ventilation: a European survey

Farré¹

2005

Eur Respir J

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“…In our bench study, a PEV was used because its leak level is stable (25–28 L/min) in the face of changes in inspiratory pressure and/or expiratory pressure. Some clinical studies have reported that the use of a PEV can eliminate CO 2 rebreathing during NPPV [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Performance Characteristics of Seven Bilevel Mechanical Ventilators in Pressure-Support Mode with Different Cycling Criteria: A Comparative Bench Study

Zhou

2015

Med Sci Monit

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BackgroundPressure support ventilation from a bilevel device is a standard technique for non-invasive home ventilation. A bench study was designed to compare the performance and patient-ventilator synchronization of 7 bilevel ventilators, in the presence of system leaks.Material/MethodsVentilators were connected to a Hans Rudolph Series 1101 lung simulator (compliance, 50 mL/cmH2O; expiratory resistance, 20 cmH2O/L/s; respiratory rate, 15 breaths/min; inspiratory time, 1.0 s). All ventilators were set at 15 cmH2O pressure support and 5 cmH2O positive end-expiratory pressure. Tests were conducted at 2 system leaks (12–15 and 25–28 L/min). The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time, and workload.ResultsThe Breas Vivo30 could not synchronize with the simulator (frequent auto-triggering) at a leak of 25–28 L/min, but provided stable assisted ventilation when the leak was 12–15 L/min. Missed efforts and back-up ventilation occurred for the Weinmann VENTImotion and Airox Smartair Plus, requiring adjustment of trigger effort. All ventilators had a short trigger delay time (<200 ms), but significant differences between devices were found in triggering workload, pressurization appearance, tidal volume, and peak inspiratory flow. Premature cycling was frequent when the inspiratory termination criteria were at the highest sensitivity. Cycling synchronization was considerably improved by modifying expiratory triggering sensitivity settings, when available.ConclusionsPerformance and triggering workload varied significantly between bilevel ventilators, possibly due to software algorithm differences. Adjusting the cycling criteria settings can alter the shape of the inspiratory phase and peak expiratory flow, and improve patient-ventilator synchrony.

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“…A high rate of gas flow is required to prevent rebreathing during normal use. 30 The risk of rebreathing decreases with increasing airway pressure (higher gas flows). The NIV systems are designed such that during normal use, the time-weighted average for inspired carbon dioxide is 1%, a limit which harmonizes with that allowed in occupational health exposure.…”

Section: Rebreathing Potential In Niv Devicesmentioning

confidence: 99%

“…5). 30 In the event of a power failure, it is expected that the sleeping patient will rouse and remove the NIV mask.…”

Section: Rebreathing Potential In Niv Devicesmentioning

confidence: 99%

Home Noninvasive Ventilation

et al. 2012

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Treatment of chronic respiratory failure with noninvasive ventilation (NIV) is standard pediatric practice, and NIV systems are commonly used in the home setting. Although practice guidelines on the perioperative management of children supported with home NIV systems have yet to be published, increasingly these patients are referred for consultation regarding perioperative management. Just as knowledge of pharmacology underlies the safe prescription of medication, so too knowledge of biomedical design is necessary for the safe prescription of NIV therapy. The medical device design requirements developed by the Organization for International Standardization provide a framework to rationalize the safe prescription of NIV for hospitalized patients supported at home with NIV systems. This review article provides an overview of the indications for home NIV therapy, an overview of the medical devices currently available to deliver it, and a specific discussion of the management conundrums confronting anesthesiologists.

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Potential Rebreathing After Continuous Positive Airway Pressure Failure During Sleep

Cited by 13 publications

References 4 publications

Quality control of equipment in home mechanical ventilation: a European survey

Quality control of equipment in home mechanical ventilation: a European survey

Performance Characteristics of Seven Bilevel Mechanical Ventilators in Pressure-Support Mode with Different Cycling Criteria: A Comparative Bench Study

Home Noninvasive Ventilation

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