Effects of Leak Compensation on Patient-Ventilator Synchrony During Premature/Neonatal Invasive and Noninvasive Ventilation: A Lung Model Study
| Autor: | Desmond J Bennett, Robert M. Kacmarek, Daniel F Fisher, Taiga Itagaki, Christopher T Chenelle |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pulmonary and Respiratory Medicine
Leak Critical Care Critical Care and Intensive Care Medicine medicine.disease_cause Models Biological Continuous mandatory ventilation law.invention 03 medical and health sciences 0302 clinical medicine law medicine Humans Computer Simulation 030212 general & internal medicine Lung Noninvasive Ventilation Ventilators Mechanical business.industry Pressure control Infant Newborn Equipment Design General Medicine Respiration Artificial Equipment Failure Analysis medicine.anatomical_structure 030228 respiratory system Anesthesia Ventilation (architecture) Breathing Equipment Failure Noninvasive ventilation business Nasal cannula |
| Zdroj: | Respiratory Care. 62:22-33 |
| ISSN: | 1943-3654 0020-1324 |
| DOI: | 10.4187/respcare.04825 |
| Popis: | During both nasal noninvasive ventilation (NIV) and invasive ventilation of neonates, the presence of air leaks causes triggering and cycling asynchrony.Five ICU ventilators (PB840, PB980, Servo-i, V500, and Avea) were compared in available invasive ventilation and NIV ventilator modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The V500 and Avea do not provide PC-CSV and PC-CMV in NIV. The Servo-i and Avea were tested with and without their proximal flow sensor. The ASL 5000 lung model (version 3.5) was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via endotracheal tube (invasive ventilation) or nasal cannula (NIV) with 4 different leaks.The Avea (without flow sensor) during invasive ventilation and Servo-i and PB840 during NIV were not triggered by inspiratory efforts of the ASL 5000 at the baseline leak in the 0.5 kg scenario. In invasive ventilation, overall (median) asynchrony index was significantly lower with the PB980 (1%) and V500 (3%) than with the Servo-i (with flow sensor, 50%; without flow sensor, 50%) and Avea (with sensor, 50%; without sensor, 62%) (P.05 for all comparisons). The PB840 (33%) was significantly different from all ventilators (P.05). In NIV, the asynchrony index was significantly lower in PB980 (2%) than in the Servo-i (with sensor, 100%; without sensor, 100%) and PB840 (75%) (P.05 for both). There was no difference in asynchrony index between PC-CSV and PC-CMV in all tested conditions and ventilators.The ability of leak compensation to prevent asynchronous breathing varied widely between ventilators and lung mechanics. The PB980 and V500 were the only two ventilators to acclimate to all leak scenarios in invasive ventilation, and PB980 was the only ventilator to acclimate to all leak scenarios in NIV. |
| Databáze: | OpenAIRE |
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