Technological development in mechanical ventilation

Conti, Giorgio; Costa, Roberta

doi:10.1097/mcc.0b013e328334b1e3

Cited by 16 publications

(5 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In accordance with previous studies, 12,13,[16][17][18] our results showed that the helmet does not perform as well as the face mask or ETT. Racca et al 19 demonstrated in 6 healthy volunteers that PSV delivered by a helmet was less effective in unloading the work of breathing compared with a face mask using the same level of support.…”

Section: Discussionsupporting

confidence: 82%

“…Compared with adults, children have a relatively higher breathing frequency, which can adversely affect patient-ventilator synchrony during PSV. 11,12 However, ventilator settings and interfaces used affect patient-ventilator synchrony in both cases. 13 Although neurally adjusted ventilatory assist (NAVA) has been proposed as a partial ventilatory support mode to improve patient-ventilator synchrony, 11,14,15 its use has been limited by the elevated cost of the catheter and need for specific equipment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

View full text Add to dashboard Cite

BACKGROUND: In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. METHODS: A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Time press ] 50% /cycling-off flow threshold [Tr exp ] 25% , Time press80% /Tr exp60% ), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. RESULTS: At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f 30 , the ETT had a reduced T press . The helmet had the shortest T press in the simulated child with a mixed obstructive and restricted respiratory condition, at f 40 during Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% . In the simulated child with a normal respiratory condition, the ETT presented the shortest T press value at f 50 during Time press80% /Tr exp60% . Concerning the expiratory trigger delay, the helmet showed the best interaction at f 30 , but the worst at f 40 and at f 50 . The helmet showed the shortest time of synchrony during all ventilator settings. CONCLUSIONS: The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The helmet demonstrated the worst interaction, suggesting that the face mask should be considered as the first choice for delivering noninvasive ventilation in a pediatric model.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

View full text Add to dashboard Cite

show abstract

“…NAVA applies a different concept of controlling the ventilator (Servoi, Maquet Critical Care, Solna, Sweden) [104][105][106][107][108][109]. The ventilator delivers synchronized assist linearly proportional to the electrical activation of the diaphragm (EAdi) during inspiration, assessed via esophageal electrodes mounted on a gastric tube [104].…”

Section: Neurally Adjusted Ventilatory Assistmentioning

confidence: 99%

Effort-adapted modes of assisted breathing

Moerer¹

2012

Current Opinion in Critical Care

View full text Add to dashboard Cite

Within recent years, a major step forward in the evolution of assisted (effort-adapted) modes of mechanical ventilation was accomplished. There is growing evidence that supports the physiological concept of closed-loop effort-adapted assisted modes of mechanical ventilation. However, at present, the translation into a clear outcome benefit remains to be proven. In order to fill the knowledge gap that impedes the broader application, larger randomized controlled trials are urgently needed. However, with clearly proven drawbacks of conventional assisted modes such as pressure support ventilation, it is probably about time to leave these modes introduced decades ago behind.

show abstract

“…During NIV, ventilator modes, settings and interfaces may deeply affect patient-ventilator interaction. Pressure Support Ventilation (PSV) still remains the mode most commonly used in PICU during NIV, although Neurally Adjusted Ventilatory Assist (NAVA) has been recently proposed to improve patient-ventilator synchrony in infants [ 8 , 9 ]. Nevertheless, NAVA requires the placement of an indwelling catheter making its use more invasive and expensive [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative bench study evaluation of different infant interfaces for non-invasive ventilation

et al. 2018

Self Cite

View full text Add to dashboard Cite

BackgroundTo compare, in terms of patient-ventilator interaction and performance, a new nasal mask (Respireo, AirLiquide, FR) with the Endotracheal tube (ET) and a commonly used nasal mask (FPM, Fisher and Paykel, NZ) for delivering Pressure Support Ventilation (PSV) in an infant model of Acute Respiratory Failure (ARF).MethodsAn active test lung (ASL 5000) connected to an infant mannequin through 3 different interfaces (Respireo, ET and FPM), was ventilated with a standard ICU ventilator set in PSV. The test lung was set to simulate a 5.5 kg infant with ARF, breathing at 50 and 60 breaths/min). Non-invasive ventilation (NIV) mode was not used and the leaks were nearly zero.ResultsThe ET showed the shortest inspiratory trigger delay and pressurization time compared to FPM and Respireo (p < 0.01). At each respiratory rate tested, the FPM showed the shortest Expiratory trigger delay compared to ET and Respireo (p < 0.01). The Respireo presented a lower value of Inspiratory pressure–time product and trigger pressure drop than ET (p < 0.01), while no significant difference was found in terms of pressure-time product at 300 and 500 ms. During all tests, compared with the FPM, ET showed a significantly higher tidal volume (VT) delivered (p < 0.01), while Respireo showed a trend toward an increase of tidal volume delivered compared with FPM.ConclusionsThe ET showed a better patient-ventilator interaction and performance compared to both the nasal masks. Despite the higher internal volume, Respireo showed a trend toward an increase of the delivered tidal volume; globally, its efficiency in terms of patient-ventilator interaction was comparable to the FPM, which is the infant NIV mask characterized by the smaller internal volume among the (few) models on the market.

show abstract

Technological development in mechanical ventilation

Cited by 16 publications

References 49 publications

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Effort-adapted modes of assisted breathing

Comparative bench study evaluation of different infant interfaces for non-invasive ventilation

Contact Info

Product

Resources

About