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Bench-test comparison of 26 emergency and transport ventilators.

L'Her E, Roy A, Marjanovic N - Crit Care (2014)

Bottom Line: Leak compensation in most ICU-like and 4/10 sophisticated devices was able to correct at least partially for system leaks, but with variations among ventilators.Major differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation.Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Numerous emergency and transport ventilators are commercialized and new generations arise constantly. The aim of this study was to evaluate a large panel of ventilators to allow clinicians to choose a device, taking into account their specificities of use.

Methods: This experimental bench-test took into account general characteristics and technical performances. Performances were assessed under different levels of FIO2 (100%, 50% or Air-Mix), respiratory mechanics (compliance 30,70,120 mL/cmH2O; resistance 5,10,20 cmH2O/mL/s), and levels of leaks (3.5 to 12.5 L/min), using a test lung.

Results: In total 26 emergency and transport ventilators were analyzed and classified into four categories (ICU-like, n = 5; Sophisticated, n = 10; Simple, n = 9; Mass-casualty and military, n = 2). Oxygen consumption (7.1 to 15.8 L/min at FIO2 100%) and the Air-Mix mode (FIO2 45 to 86%) differed from one device to the other. Triggering performance was heterogeneous, but several sophisticated ventilators depicted triggering capabilities as efficient as ICU-like ventilators. Pressurization was not adequate for all devices. At baseline, all the ventilators were able to synchronize, but with variations among respiratory conditions. Leak compensation in most ICU-like and 4/10 sophisticated devices was able to correct at least partially for system leaks, but with variations among ventilators.

Conclusion: Major differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation. Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.

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Box plot of tidal volume according to respiratory mechanics variations in the different categories of emergency and transport ventilators (ETV). VT, tidal volume; R, different values of resistance were applied (5, 10 and 20 cm H2O/L/s) in combination with different compliance (30, 70, 120 cm H2O/L); dotted line represents the 10% VT accuracy range; values are provided as mean (95% CI) ± STD; a P value equal to or below 0.05 was considered significant. ICU-like emergency and transport ventilators (ETV; n = 5) are devices that, even if transportable, cannot be considered for transportation on a routine basis; sophisticated ETV (n = 10) usually depicts curves monitoring screens and allow noninvasive ventilation; simple ETV (n = 9) are standard devices, providing no extensive monitoring; mass-casualty/military ETV (n = 2) are devices dedicated for field operations. They are quite heavy, depict little monitoring, but are very robust and may run without oxygen availability. Significant VT variations according to respiratory mechanics changes were observed for all categories, except simple ETV; all ventilators in the ICU-like and sophisticated categories were within the 10% accuracy range for VT, whereas most in the simple and in the mass-casualty/military category were outside the range.
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Fig1: Box plot of tidal volume according to respiratory mechanics variations in the different categories of emergency and transport ventilators (ETV). VT, tidal volume; R, different values of resistance were applied (5, 10 and 20 cm H2O/L/s) in combination with different compliance (30, 70, 120 cm H2O/L); dotted line represents the 10% VT accuracy range; values are provided as mean (95% CI) ± STD; a P value equal to or below 0.05 was considered significant. ICU-like emergency and transport ventilators (ETV; n = 5) are devices that, even if transportable, cannot be considered for transportation on a routine basis; sophisticated ETV (n = 10) usually depicts curves monitoring screens and allow noninvasive ventilation; simple ETV (n = 9) are standard devices, providing no extensive monitoring; mass-casualty/military ETV (n = 2) are devices dedicated for field operations. They are quite heavy, depict little monitoring, but are very robust and may run without oxygen availability. Significant VT variations according to respiratory mechanics changes were observed for all categories, except simple ETV; all ventilators in the ICU-like and sophisticated categories were within the 10% accuracy range for VT, whereas most in the simple and in the mass-casualty/military category were outside the range.

Mentions: All ETV in the ICU-like and sophisticated categories were within the accuracy range for VT, whatever respiratory mechanics combinations, while major deviations were observed in the other categories (Figure 1).Figure 1


Bench-test comparison of 26 emergency and transport ventilators.

L'Her E, Roy A, Marjanovic N - Crit Care (2014)

Box plot of tidal volume according to respiratory mechanics variations in the different categories of emergency and transport ventilators (ETV). VT, tidal volume; R, different values of resistance were applied (5, 10 and 20 cm H2O/L/s) in combination with different compliance (30, 70, 120 cm H2O/L); dotted line represents the 10% VT accuracy range; values are provided as mean (95% CI) ± STD; a P value equal to or below 0.05 was considered significant. ICU-like emergency and transport ventilators (ETV; n = 5) are devices that, even if transportable, cannot be considered for transportation on a routine basis; sophisticated ETV (n = 10) usually depicts curves monitoring screens and allow noninvasive ventilation; simple ETV (n = 9) are standard devices, providing no extensive monitoring; mass-casualty/military ETV (n = 2) are devices dedicated for field operations. They are quite heavy, depict little monitoring, but are very robust and may run without oxygen availability. Significant VT variations according to respiratory mechanics changes were observed for all categories, except simple ETV; all ventilators in the ICU-like and sophisticated categories were within the 10% accuracy range for VT, whereas most in the simple and in the mass-casualty/military category were outside the range.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197290&req=5

Fig1: Box plot of tidal volume according to respiratory mechanics variations in the different categories of emergency and transport ventilators (ETV). VT, tidal volume; R, different values of resistance were applied (5, 10 and 20 cm H2O/L/s) in combination with different compliance (30, 70, 120 cm H2O/L); dotted line represents the 10% VT accuracy range; values are provided as mean (95% CI) ± STD; a P value equal to or below 0.05 was considered significant. ICU-like emergency and transport ventilators (ETV; n = 5) are devices that, even if transportable, cannot be considered for transportation on a routine basis; sophisticated ETV (n = 10) usually depicts curves monitoring screens and allow noninvasive ventilation; simple ETV (n = 9) are standard devices, providing no extensive monitoring; mass-casualty/military ETV (n = 2) are devices dedicated for field operations. They are quite heavy, depict little monitoring, but are very robust and may run without oxygen availability. Significant VT variations according to respiratory mechanics changes were observed for all categories, except simple ETV; all ventilators in the ICU-like and sophisticated categories were within the 10% accuracy range for VT, whereas most in the simple and in the mass-casualty/military category were outside the range.
Mentions: All ETV in the ICU-like and sophisticated categories were within the accuracy range for VT, whatever respiratory mechanics combinations, while major deviations were observed in the other categories (Figure 1).Figure 1

Bottom Line: Leak compensation in most ICU-like and 4/10 sophisticated devices was able to correct at least partially for system leaks, but with variations among ventilators.Major differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation.Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Numerous emergency and transport ventilators are commercialized and new generations arise constantly. The aim of this study was to evaluate a large panel of ventilators to allow clinicians to choose a device, taking into account their specificities of use.

Methods: This experimental bench-test took into account general characteristics and technical performances. Performances were assessed under different levels of FIO2 (100%, 50% or Air-Mix), respiratory mechanics (compliance 30,70,120 mL/cmH2O; resistance 5,10,20 cmH2O/mL/s), and levels of leaks (3.5 to 12.5 L/min), using a test lung.

Results: In total 26 emergency and transport ventilators were analyzed and classified into four categories (ICU-like, n = 5; Sophisticated, n = 10; Simple, n = 9; Mass-casualty and military, n = 2). Oxygen consumption (7.1 to 15.8 L/min at FIO2 100%) and the Air-Mix mode (FIO2 45 to 86%) differed from one device to the other. Triggering performance was heterogeneous, but several sophisticated ventilators depicted triggering capabilities as efficient as ICU-like ventilators. Pressurization was not adequate for all devices. At baseline, all the ventilators were able to synchronize, but with variations among respiratory conditions. Leak compensation in most ICU-like and 4/10 sophisticated devices was able to correct at least partially for system leaks, but with variations among ventilators.

Conclusion: Major differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation. Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.

Show MeSH
Related in: MedlinePlus