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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.

Show MeSH
Pressure support accuracy under different levels of leaks. Values are provided as % difference as compared to settings (pressure support (PS) = 10 cm H2O with an additional positive end-expiratory pressure (PEEP) level = 5 cm H2O); dotted line represents the a priori defined accuracy range (±10%); three levels of leaks were used: L1 = 3.5 to 4.0 L/minute; L2 = 5.0 to 7.0 L/minute; L3 = 9.0 to 12.5 L/minute. Several devices were quite insensitive to leaks, with PS variation near zero; statistical analysis evaluated the impact of leaks over PS accuracy and a P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Of the ETV, 10/15 provided PS within an accuracy range equal to or less than 10%. If 4/15 ETV were statistically influenced by leaks, only one might be considered as influenced with a clinical relevance, the other one being within the accuracy range.
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Fig6: Pressure support accuracy under different levels of leaks. Values are provided as % difference as compared to settings (pressure support (PS) = 10 cm H2O with an additional positive end-expiratory pressure (PEEP) level = 5 cm H2O); dotted line represents the a priori defined accuracy range (±10%); three levels of leaks were used: L1 = 3.5 to 4.0 L/minute; L2 = 5.0 to 7.0 L/minute; L3 = 9.0 to 12.5 L/minute. Several devices were quite insensitive to leaks, with PS variation near zero; statistical analysis evaluated the impact of leaks over PS accuracy and a P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Of the ETV, 10/15 provided PS within an accuracy range equal to or less than 10%. If 4/15 ETV were statistically influenced by leaks, only one might be considered as influenced with a clinical relevance, the other one being within the accuracy range.

Mentions: Of the ETV, 15/26 (58%) were presumed to allow NIV, of which 4/15 (27%) did not provide PS reliability, whatever respiratory mechanics and leaks (Figure 6).Figure 6


Bench-test comparison of 26 emergency and transport ventilators.

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

Pressure support accuracy under different levels of leaks. Values are provided as % difference as compared to settings (pressure support (PS) = 10 cm H2O with an additional positive end-expiratory pressure (PEEP) level = 5 cm H2O); dotted line represents the a priori defined accuracy range (±10%); three levels of leaks were used: L1 = 3.5 to 4.0 L/minute; L2 = 5.0 to 7.0 L/minute; L3 = 9.0 to 12.5 L/minute. Several devices were quite insensitive to leaks, with PS variation near zero; statistical analysis evaluated the impact of leaks over PS accuracy and a P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Of the ETV, 10/15 provided PS within an accuracy range equal to or less than 10%. If 4/15 ETV were statistically influenced by leaks, only one might be considered as influenced with a clinical relevance, the other one being within the accuracy range.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig6: Pressure support accuracy under different levels of leaks. Values are provided as % difference as compared to settings (pressure support (PS) = 10 cm H2O with an additional positive end-expiratory pressure (PEEP) level = 5 cm H2O); dotted line represents the a priori defined accuracy range (±10%); three levels of leaks were used: L1 = 3.5 to 4.0 L/minute; L2 = 5.0 to 7.0 L/minute; L3 = 9.0 to 12.5 L/minute. Several devices were quite insensitive to leaks, with PS variation near zero; statistical analysis evaluated the impact of leaks over PS accuracy and a P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Of the ETV, 10/15 provided PS within an accuracy range equal to or less than 10%. If 4/15 ETV were statistically influenced by leaks, only one might be considered as influenced with a clinical relevance, the other one being within the accuracy range.
Mentions: Of the ETV, 15/26 (58%) were presumed to allow NIV, of which 4/15 (27%) did not provide PS reliability, whatever respiratory mechanics and leaks (Figure 6).Figure 6

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