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Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study.

Nakamura MA, Costa EL, Carvalho CR, Tucci MR - J Bras Pneumol (2014 May-Jun)

Bottom Line: The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization.Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly.The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.

View Article: PubMed Central - PubMed

Affiliation: Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.

ABSTRACT

Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM.

Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization.

Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly.

Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.

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Related in: MedlinePlus

Características de pressurização de cinco dos ventiladores testados,demonstradas pelo produto da pressão e tempo inspiratórios a 500 ms (PPT500;círculos vazados) e a 1 s (PPTt; círculos preenchidos), em porcentagem deárea ideal. Os traços horizontais indicam as médias de todas as medidas(pressão expiratória final positiva de 5 e 10 cmH2O vs. pressão de suportede 5, 10 e 15 cmH2O) disponíveis para os ventiladores.
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f07: Características de pressurização de cinco dos ventiladores testados,demonstradas pelo produto da pressão e tempo inspiratórios a 500 ms (PPT500;círculos vazados) e a 1 s (PPTt; círculos preenchidos), em porcentagem deárea ideal. Os traços horizontais indicam as médias de todas as medidas(pressão expiratória final positiva de 5 e 10 cmH2O vs. pressão de suportede 5, 10 e 15 cmH2O) disponíveis para os ventiladores.

Mentions: O ventilador Horus teve a menor PIP na máscara (Figura E2, disponível no site doJornal Brasileiro de Pneumologia:http://www.jornaldepneumologia.com.br/imagebank/images/jbp_v40n3_suplemento.pdf).Todos os outros ventiladores atingiram PIP semelhantes. O BiPAP Vision apresentou osmaiores valores de PPT500 e PPTt (Figura 3). Oe500 e o Horus apresentaram os menores valores de PPT500.


Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study.

Nakamura MA, Costa EL, Carvalho CR, Tucci MR - J Bras Pneumol (2014 May-Jun)

Características de pressurização de cinco dos ventiladores testados,demonstradas pelo produto da pressão e tempo inspiratórios a 500 ms (PPT500;círculos vazados) e a 1 s (PPTt; círculos preenchidos), em porcentagem deárea ideal. Os traços horizontais indicam as médias de todas as medidas(pressão expiratória final positiva de 5 e 10 cmH2O vs. pressão de suportede 5, 10 e 15 cmH2O) disponíveis para os ventiladores.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109202&req=5

f07: Características de pressurização de cinco dos ventiladores testados,demonstradas pelo produto da pressão e tempo inspiratórios a 500 ms (PPT500;círculos vazados) e a 1 s (PPTt; círculos preenchidos), em porcentagem deárea ideal. Os traços horizontais indicam as médias de todas as medidas(pressão expiratória final positiva de 5 e 10 cmH2O vs. pressão de suportede 5, 10 e 15 cmH2O) disponíveis para os ventiladores.
Mentions: O ventilador Horus teve a menor PIP na máscara (Figura E2, disponível no site doJornal Brasileiro de Pneumologia:http://www.jornaldepneumologia.com.br/imagebank/images/jbp_v40n3_suplemento.pdf).Todos os outros ventiladores atingiram PIP semelhantes. O BiPAP Vision apresentou osmaiores valores de PPT500 e PPTt (Figura 3). Oe500 e o Horus apresentaram os menores valores de PPT500.

Bottom Line: The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization.Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly.The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.

View Article: PubMed Central - PubMed

Affiliation: Heart Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.

ABSTRACT

Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM.

Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization.

Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly.

Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM.

Show MeSH
Related in: MedlinePlus