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A comparison of leak compensation in acute care ventilators during non-invasive and invasive ventilation; a lung model study.
MedLine Citation:
PMID:  23696688     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:Although leak compensation has been widely introduced to acute care ventilators to improve patient-ventilator synchronization in the presence of system leaks, there is no data on these ventilators ability to prevent triggering and cycling asynchrony. The goal of this study was to evaluate the ability of leak compensation in acute care ventilators during invasive and non-invasive ventilation (NIV).Methods:Using a lung simulator, the impact of system leaks was compared on 7 ICU ventilators and 1 dedicated NIV ventilator during triggering and cycling at two respiratory mechanics (COPD and ARDS models) settings, various modes of ventilation (NIV mode: pressure support ventilation; and invasive mode: pressure support and pressure assist/control), and two PEEP levels (5, and 10 cmH2O). Leak levels used were up to 35-36 L/min in NIV mode and 26-27 L/min in invasive mode.Results:Although all of the ventilators were able to synchronize with the simulator at baseline, only 4 of the 8 ventilators synchronized to all leaks in NIV and 2 of 8 ventilators in invasive ventilation. The number of breaths to synchronization was higher in increasing than decreasing leak. In the COPD model, miss-triggering occurred more frequently and required a longer time to stabilized tidal volumes than in the ARDS model. The PB840 required fewer breaths to synchronize in both invasive and NIV modes compared with the other ventilators (p < 0.001).Conclusions:Leak compensation in invasive and NIV modes has wide variations between ventilators. The PB840 and the V60 were the only ventilators to acclimate to all leaks but there were differences in performance between these two ventilators. It is not clear if these differences have clinical significance.
Authors:
Jun Oto; Christopher T Chenelle; Andrew D Marchese; Robert M Kacmarek
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-21
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Research fellow Respiratory Care Services, Massachusetts General Hospital.
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