Ventilatory Modes. What's in a Name?The authors respond:

Rabec, Claudio; Chatburn, Robert L; Langevin, Brigitte; Rodenstein, Daniel; Perrin, Christophe; Léger, P; Pépin, Jean‐Louis; Janssens, J.-P.; Gonzalez-Bermejo, Jésus

doi:10.4187/respcare.02122

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…There are also data gaps regarding systematic evaluation of NIV-related side effects. In particular, sleep disturbances caused by triggering problems and/or leakage events have been largely ignored until now, although some groups have proposed assessing these problems in systematic studies 19,20…”

Section: Introductionmentioning

confidence: 99%

Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

Nilius¹,

Katamadze²,

Domanski³

et al. 2017

COPD

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BackgroundCOPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known.ObjectivesThis study compared the effects of pressure-controlled (spontaneous timed [ST]) non-invasive ventilation (NIV) and NIV with intelligent volume-assured pressure support (IVAPS) in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality.MethodsThis prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG) and transcutaneous carbon dioxide pressure (PtcCO2) measurement. Patients rated their subjective experience (total score, 0–45; lower scores indicate better acceptability).ResultsFourteen patients were included (4 females, age 59.4±8.9 years). The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7) and IVAPS (8.3±10.2) conditions (P=0.064). There were also no clinically relevant differences in PtcCO2 between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg). Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH2O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]). Overall patient assessment scores were similar, although there was a trend toward less discomfort during IVAPS.ConclusionOur results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep quality or inducing ventilation- associated events.

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Section: Introductionmentioning

confidence: 99%

Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

Nilius¹,

Katamadze²,

Domanski³

et al. 2017

COPD

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“…Nevertheless, the fact that manufacturers have no restrictions on the definitions of respiratory support modes is somewhat confusing for the end user. Indeed, in many cases, an algorithm or ventilation mode proposed by a manufacturer as being exclusive for its device is based on almost the same concept, but with a different registered trademark name, than the option proposed by another manufacturer [7]. The fact that 174 unique names for modes of ventilation were reported in 2010 [5], with new ones being added since then, illustrates how complex it is to distinguish ventilation devices, not only for clinicians but also for experts in this technology.…”

Section: The Black Boxmentioning

confidence: 99%

“…Ignoring the details of how a device works does not allow the user to ascertain what the potential differences are between devices and whether these differences are reasonably substantial from a clinical viewpoint. In fact, for the conventional user, most current ventilatory support devices appear to be a black box [7, 8]. …”

Section: The Black Boxmentioning

confidence: 99%

Technology for noninvasive mechanical ventilation: looking into the black box

2016

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Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients. This concise review presents an updated perspective of the theoretical basis of intelligent continuous positive airway pressure and noninvasive ventilation devices, and of the tools available for assessing how these devices respond under specific ventilation phenotypes in patients requiring breathing support.

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“…And before a taxonomy can be constructed, there must be a standardized glossary (or controlled vocabulary, as it is called by taxonomists) of relevant terms. 15,23 The need for a standardized vocabulary is the reason we included one in the supplementary materials (http://www.rcjournal.com). This vocabulary has been carefully developed by the authors over the last 20 years with the specific purpose of establishing basic concepts that are logically consistent across all applications.…”

Section: The Problem Of Identifying Unique Modesmentioning

confidence: 99%

“…A full explanation of how taxonomies are created, as it applies to mechanical ventilation, has been published previously. 15 In short, the first step is to create a standardized set of definitions. We have refined such a vocabulary over the last 20 years (see the supplementary materials at http://www.rcjournal.com).…”

Section: The 10 Maximsmentioning

confidence: 99%

A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims

2014

Self Cite

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The American Association for Respiratory Care has declared a benchmark for competency in mechanical ventilation that includes the ability to "apply to practice all ventilation modes currently available on all invasive and noninvasive mechanical ventilators." This level of competency presupposes the ability to identify, classify, compare, and contrast all modes of ventilation. Unfortunately, current educational paradigms do not supply the tools to achieve such goals. To fill this gap, we expand and refine a previously described taxonomy for classifying modes of ventilation and explain how it can be understood in terms of 10 fundamental constructs of ventilator technology: (1) defining a breath, (2) defining an assisted breath, (3) specifying the means of assisting breaths based on control variables specified by the equation of motion, (4) classifying breaths in terms of how inspiration is started and stopped, (5) identifying ventilator-initiated versus patient-initiated start and stop events, (6) defining spontaneous and mandatory breaths, (7) defining breath sequences (8), combining control variables and breath sequences into ventilatory patterns, (9) describing targeting schemes, and (10) constructing a formal taxonomy for modes of ventilation composed of control variable, breath sequence, and targeting schemes. Having established the theoretical basis of the taxonomy, we demonstrate a step-by-step procedure to classify any mode on any mechanical ventilator.

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Ventilatory Modes. What's in a Name?The authors respond:

Cited by 8 publications

References 14 publications

Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

Technology for noninvasive mechanical ventilation: looking into the black box

A Taxonomy for Mechanical Ventilation: 10 Fundamental Maxims

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