Correction of error in respiratory resistance measurements made with the flow-interruption technique during mechanical ventilation: evaluation of the puritan bennett 7200 and 840 ventilators.
BACKGROUND
Calculation of total inspiratory resistance (Rtot) for patients on ventilatory support is typically based on measurement of airflow velocity and airway opening pressure during end-inspiratory occlusion by the inspiratory valve in the ventilator. Systematic error is introduced into Rtot measurements because the inspiratory valve closes over a period of time (not instantaneously, so gas continues to flow into the circuit while the valve is shutting) and because the circuit tubing is a distensible compartment between the occluding valve and the respiratory system. The Rtot-measurement error can be minimized with a rapidly-shutting occlusion valve positioned at the airway opening, or, alternatively, by mathematical correction that accounts for the valve-closure period and circuit tubing characteristics.


METHODS
In a bench study we measured Rtot with the Puritan Bennett 7200 and 840 ventilators (using the inspiratory valves that are built into those ventilators) and compared those measurements to measurements made with a rapidly-shutting valve at the airway opening. We deemed the rapid-occlusion-valve measurements the best available (benchmark) values. We also studied the closure characteristics of the ventilators' inspiratory occlusion valves and created equations for mathematical correction of Rtot values measured with those valves.


RESULTS
Compared to the benchmark measurements, the measurements from the Puritan Bennett 7200 averaged 23.2% relative error and 2.6 cm H2O/L/s absolute error. Measurements from the Puritan Bennett 840 averaged 7.3% relative error and 1.0 cm H2O/L/s absolute error. Mathematical correction for the circuit tubing and valve-closure time reduced the average relative and absolute error to 3.0% and 0.4 cm H2O/L/s, respectively, for the Puritan Bennett 7200, and to 4.5% and 0.3 cm H2O/L/s, respectively, for the Puritan Bennett 840.


CONCLUSIONS
The Puritan Bennett 840 measures Rtot more accurately than the Puritan Bennett 7200. Our equations to mathematically correct Rtot measurements made with the PB7200 and PB840 are useful in settings where very accurate Rtot measurements are necessary.
Lit
Louis M
LM
Department of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY, USA. lou_lit@hotmail.com.
Doelken
Peter
P
Mayo
Paul H
PH
D000403:Airway Resistance / Q000502:physiology*; D019985:Benchmarking; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D007320:Inspiratory Capacity / Q000502:physiology*; D008176:Lung Volume Measurements; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000295:instrumentation / Q000592:standards*; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D012122:Ventilators, Mechanical