Bilevel vs ICU Ventilators Providing Noninvasive Ventilation: Effect of System Leaks: A COPD Lung Model Comparison

摘要

Background: Noninvasive positive-pressure ventilation (NPPV) modes are currently available onnbilevel and ICU ventilators. However, little data comparing the performance of the NPPV modesnon these ventilators are available.nMethods: In an experimental bench study, the ability of nine ICU ventilators to function in thenpresence of leaks was compared with a bilevel ventilator using the IngMar ASL5000 lungnsimulator (IngMar Medical; Pittsburgh, PA) set at a compliance of 60 mL/cm H2O, an inspiratorynresistance of 10 cm H2O/L/s, an expiratory resistance of 20 cm H2O/ L/s, and a respiratory rate ofn15 breaths/min. All of the ventilators were set at 12 cm H2O pressure support and 5 cm H2Onpositive end-expiratory pressure. The data were collected at baseline and at three customizednleaks.nMain results: At baseline, all of the ventilators were able to deliver adequate tidal volumes, tonmaintain airway pressure, and to synchronize with the simulator, without missed efforts ornauto-triggering. As the leak was increased, all of the ventilators (except the Vision [Respironics;nMurrysville, PA] and Servo I [Maquet; Solna, Sweden]) needed adjustment of sensitivity or cyclingncriteria to maintain adequate ventilation, and some transitioned to backup ventilation. Significantndifferences in triggering and cycling were observed between the Servo I and the Visionnventilators.nConclusions: The Vision and Servo I were the only ventilators that required no adjustments asnthey adapted to increasing leaks. There were differences in performance between these twonventilators, although the clinical significance of these differences is unclear. Clinicians should benaware that in the presence of leaks, most ICU ventilators require adjustments to maintain annadequate tidal volume