title: Noninvasive ventilator triggering in chronic obstructive pulmonary disease. A test lung comparison.
abstract: To be most effective, noninvasive ventilation (NIV) ventilators should synchronize well with patients' breathing. However, the speed with which different ventilators can respond to the transitions between inspiration and expiration may vary, and abnormal respiratory mechanics and mask leaks may exacerbate this problem. This study explored synchronization using a new test lung model designed to simulate acute exacerbations of chronic obstructive pulmonary disease (COPD). Thirteen ventilators were tested against different combinations of tidal volume (VT), airways resistance (Raw), FRC, and mask leak. These combinations ranged from those of a severe exacerbation of COPD, to a mild condition reflecting the optimal triggering conditions a ventilator is likely to encounter. The triggering delays from the beginning and end of "inspiration" of the test lung, to the appropriate responses from the ventilators were measured. Three of the ventilators had trigger delays less than approximately 120 ms at both the beginning and end of expiration under all conditions. Trigger delays of other ventilators were mainly in the range of 120 to 300 ms, although exceptionally as long as 500 ms. Varying the conditions had a variable but generally small effect on triggering times, suggesting that there is a largely unavoidable element to the triggering delays intrinsic to the design of the ventilators.
authors.affiliation: Department of Accident and Emergency Medicine, Guy's, Kings and St. Thomas' School of Medicine, King's College Hospital, London, United Kingdom. ian.stell@bromleyh-tr.sthames.nhs.uk
authors.forename: I M
authors.initials: IM
authors.lastname: Stell
authors.forename: G
authors.initials: G
authors.lastname: Paul
authors.forename: K C
authors.initials: KC
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Ponte
authors.forename: J
authors.initials: J
authors.lastname: Moxham
mesh_terms: D000208:Acute Disease; D000403:Airway Resistance; D004867:Equipment Design; D005652:Functional Residual Capacity; D006801:Humans; D008422:Materials Testing; D018467:Positive-Pressure Respiration, Intrinsic / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015656:Respiratory Mechanics; D012720:Severity of Illness Index; D013990:Tidal Volume; D013997:Time Factors; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000592:standards* / Q000600:supply & distribution; D014939:Work of Breathing