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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: Triggering performance was heterogeneous, but several sophisticated ventilators depicted triggering capabilities as efficient as ICU-like ventilators.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.

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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Asynchrony management under different levels of leaks, with/without the noninvasive ventilation (NIV) mode. Asynchrony index (AI) values are provided as% of respiratory efforts under pressure support (PS) ventilation (PS = 10 cm H2O + positive end-expiratory pressure (PEEP) = 5 cm H2O); dotted line represents the AI clinical level of significance (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. Measurements were performed under triggering modalities defined by the factory settings, and then under the noninvasive ventilation mode if available. Statistical analysis evaluated the impact of leaks over AI occurrence and the effect of the NIV mode; A P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Most devices except one did not depict an AI variation according to increased leaks. The NIV mode effect was significant for most ICU-like devices, whereas results were heterogeneous for the sophisticated category. Several sophisticated devices depicted better results in terms of asynchrony management than mean ICU-like devices. Mass casualty/military devices were not tested as they do not enable spontaneous ventilation.
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Fig7: Asynchrony management under different levels of leaks, with/without the noninvasive ventilation (NIV) mode. Asynchrony index (AI) values are provided as% of respiratory efforts under pressure support (PS) ventilation (PS = 10 cm H2O + positive end-expiratory pressure (PEEP) = 5 cm H2O); dotted line represents the AI clinical level of significance (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. Measurements were performed under triggering modalities defined by the factory settings, and then under the noninvasive ventilation mode if available. Statistical analysis evaluated the impact of leaks over AI occurrence and the effect of the NIV mode; A P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Most devices except one did not depict an AI variation according to increased leaks. The NIV mode effect was significant for most ICU-like devices, whereas results were heterogeneous for the sophisticated category. Several sophisticated devices depicted better results in terms of asynchrony management than mean ICU-like devices. Mass casualty/military devices were not tested as they do not enable spontaneous ventilation.

Mentions: Leak increases did not modify the AI for ICU-like ETV, while it influenced efficiency for three sophisticated ETV (Figure 7). For all ICU-like ETV except one, the NIV mode enabled an AI decrease <10%. Huge heterogeneity of the NIV-mode effect was observed within the sophisticated ETV category.Figure 7


Bench-test comparison of 26 emergency and transport ventilators.

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

Asynchrony management under different levels of leaks, with/without the noninvasive ventilation (NIV) mode. Asynchrony index (AI) values are provided as% of respiratory efforts under pressure support (PS) ventilation (PS = 10 cm H2O + positive end-expiratory pressure (PEEP) = 5 cm H2O); dotted line represents the AI clinical level of significance (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. Measurements were performed under triggering modalities defined by the factory settings, and then under the noninvasive ventilation mode if available. Statistical analysis evaluated the impact of leaks over AI occurrence and the effect of the NIV mode; A P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Most devices except one did not depict an AI variation according to increased leaks. The NIV mode effect was significant for most ICU-like devices, whereas results were heterogeneous for the sophisticated category. Several sophisticated devices depicted better results in terms of asynchrony management than mean ICU-like devices. Mass casualty/military devices were not tested as they do not enable spontaneous ventilation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig7: Asynchrony management under different levels of leaks, with/without the noninvasive ventilation (NIV) mode. Asynchrony index (AI) values are provided as% of respiratory efforts under pressure support (PS) ventilation (PS = 10 cm H2O + positive end-expiratory pressure (PEEP) = 5 cm H2O); dotted line represents the AI clinical level of significance (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. Measurements were performed under triggering modalities defined by the factory settings, and then under the noninvasive ventilation mode if available. Statistical analysis evaluated the impact of leaks over AI occurrence and the effect of the NIV mode; A P-value equal to or below 0.05 was considered significant; *P <0.05; **P <0.005. Most devices except one did not depict an AI variation according to increased leaks. The NIV mode effect was significant for most ICU-like devices, whereas results were heterogeneous for the sophisticated category. Several sophisticated devices depicted better results in terms of asynchrony management than mean ICU-like devices. Mass casualty/military devices were not tested as they do not enable spontaneous ventilation.
Mentions: Leak increases did not modify the AI for ICU-like ETV, while it influenced efficiency for three sophisticated ETV (Figure 7). For all ICU-like ETV except one, the NIV mode enabled an AI decrease <10%. Huge heterogeneity of the NIV-mode effect was observed within the sophisticated ETV category.Figure 7

Bottom Line: Triggering performance was heterogeneous, but several sophisticated ventilators depicted triggering capabilities as efficient as ICU-like ventilators.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.

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