Document Detail

High flow biphasic positive airway pressure by helmet--effects on pressurization, tidal volume, carbon dioxide accumulation and noise exposure.
MedLine Citation:
PMID:  19500369     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Non-invasive ventilation (NIV) with a helmet device is often associated with poor patient-ventilator synchrony and impaired carbon dioxide (CO2) removal, which might lead to failure. A possible solution is to use a high free flow system in combination with a time-cycled pressure valve placed into the expiratory circuit (HF-BiPAP). This system would be independent from triggering while providing a high flow to eliminate CO2.
METHODS: Conventional pressure support ventilation (PSV) and time-cycled biphasic pressure controlled ventilation (BiVent) delivered by an Intensive Care Unit ventilator were compared to HF-BiPAP in an in vitro lung model study. Variables included delta pressures of 5 and 15 cmH2O, respiratory rates of 15 and 30 breaths/min, inspiratory efforts (respiratory drive) of 2.5 and 10 cmH2O) and different lung characteristics. Additionally, CO2 removal and noise exposure were measured.
RESULTS: Pressurization during inspiration was more effective with pressure controlled modes compared to PSV (P < 0.001) at similar tidal volumes. During the expiratory phase, BiVent and HF-BiPAP led to an increase in pressure burden compared to PSV. This was especially true at higher upper pressures (P < 0.001). At high level of asynchrony both HF-BiPAP and BiVent were less effective. Only HF-BiPAP ventilation effectively removed CO2 (P < 0.001) during all settings. Noise exposure was higher during HF-BiPAP (P < 0.001).
CONCLUSIONS: This study demonstrates that in a lung model, the efficiency of NIV by helmet can be improved by using HF-BiPAP. However, it imposes a higher pressure during the expiratory phase. CO2 was almost completely removed with HF-BiPAP during all settings.
Onnen Moerer; Peter Herrmann; José Hinz; Paolo Severgnini; Edoardo Calderini; Michael Quintel; Paolo Pelosi
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-06-05
Journal Detail:
Title:  Critical care (London, England)     Volume:  13     ISSN:  1466-609X     ISO Abbreviation:  Crit Care     Publication Date:  2009  
Date Detail:
Created Date:  2009-07-29     Completed Date:  2009-10-28     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9801902     Medline TA:  Crit Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  R85     Citation Subset:  IM    
Department of Anaesthesiology, Emergency and Critical Care Medicine, University of Göttingen, 37075 Göttingen, Germany.
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MeSH Terms
Carbon Dioxide / metabolism
Models, Theoretical
Positive-Pressure Respiration / instrumentation*,  methods*
Tidal Volume
Reg. No./Substance:
124-38-9/Carbon Dioxide

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