Harms of unintentional leaks during volume targeted pressure support ventilation

Autor: Khirani, Sonia, Louis, Bruno, Leroux, Karl, Delord, Vincent, Fauroux, Brigitte, Lofaso, Frédéric
Přispěvatelé: Guellaen, Georges, INSERM U955, équipe 13, S2A Santé, S2A Santé-S2A Santé-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), ADEP ASSISTANCE, ADEP assistance, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Role des Cellules Dendritiques Dans la Regulation des Effecteurs de l'Immunite Antitumorale, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Institut Mondor de Recherche Biomédicale (IMRB)
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: Respiratory Medicine
Respiratory Medicine, 2013, 107 (7), pp.1021-9. ⟨10.1016/j.rmed.2013.03.013⟩
ISSN: 0954-6111
DOI: 10.1016/j.rmed.2013.03.013⟩
Popis: International audience; BACKGROUND: Volume targeted pressure support ventilation (VT-PSV) is a hybrid mode increasingly used to maintain a minimal tidal volume (VT) by automatically adjusting the level of inspiratory pressure. The objective of the study was to determine the ability of home ventilators to maintain the preset minimal VT during unintentional leaks in a VT-PSV mode. METHODS: Seven ventilators were tested on a lung bench with different circuit configurations and with different levels of unintentional leaks. Unintentional leaks were generated using calibrated holes. RESULTS: All the studied ventilators with a single-limb circuit with intentional leak (n = 5) were able to maintain the minimal preset VT during unintentional leaks. One ventilator overcompensated VT during unintentional leaks of high intensity. In contrast, all studied ventilators with a single circuit with an expiratory valve (n = 2) or a double-circuit (n = 3) but one failed to maintain the minimal VT during unintentional leaks. Unintentional leaks generated a decrease in inspiratory pressure, which was responsible for the fall in VT. CONCLUSIONS: Most of the studied ventilators with a single-limb circuit with intentional leak correctly estimate the expiratory VT and therefore successfully maintain the preset minimal VT during unintentional leaks, in contrast to most of the studied ventilators with a double-circuit, which paradoxically are not able to directly measure expiratory VT. Importantly, the VT-PSV mode, when used with most ventilators with expiratory valve or double-circuit, can paradoxically exacerbate the VT drop during unintentional leaks.
Databáze: OpenAIRE
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