title: Inspiratory oscillatory flow with a portable ventilator: a bench study.
abstract: BACKGROUND
  We observed an oscillatory flow while ventilating critically ill patients with the Dräger Oxylog 3000 transport ventilator during interhospital transfer. The phenomenon occurred in paediatric patients or in adult patients with severe airway obstruction ventilated in the pressure-regulated or pressure-controlled mode. As this had not been described previously, we conducted a bench study to investigate the phenomenon.
  
  
  METHODS
  An Oxylog 3000 intensive care unit ventilator and a Dräger Medical Evita-4 NeoFlow intensive care unit ventilator were connected to a Dräger Medical LS800 lung simulator. Data were registered by a Datex-S5 Monitor with a D-fend flow and pressure sensor, and were analysed with a laptop using S5-Collect software. Clinical conditions were simulated using various ventilatory modes, using various ventilator settings, using different filters and endotracheal tubes, and by changing the resistance and compliance. Data were recorded for 258 combinations of patient factors and respirator settings to detect thresholds for the occurrence of the phenomenon and methods to overcome it.
  
  
  RESULTS
  Under conditions with high resistance in pressure-regulated ventilation with the Oxylog 3000, an oscillatory flow during inspiration produced rapid changes of the airway pressure. The phenomenon resulted in a jerky inspiration with high peak airway pressures, higher than those set on the ventilator. Reducing the inspiratory flow velocity was effective to terminate the phenomenon, but resulted in reduced tidal volumes.
  
  
  CONCLUSIONS
  Oscillatory flow with potentially harmful effects may occur during ventilation with the Dräger Oxylog 3000, especially in conditions with high resistance such as small airways in children (endotracheal tube internal diameter <6 mm) or severe obstructive lung diseases or airway diseases in adult patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care, General Hospital Barmherzige Brüder Eisenstadt, Austria. guenther.frank@bbeisen.at
authors.forename: Guenther E
authors.initials: GE
authors.lastname: Frank
authors.forename: Helmut
authors.initials: H
authors.lastname: Trimmel
authors.forename: Robert D
authors.initials: RD
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D035641:Chest Wall Oscillation / Q000295:instrumentation; D002648:Child; D003422:Critical Care / Q000379:methods; D019544:Equipment Failure Analysis; D006801:Humans; D001239:Inhalation; D008170:Lung Compliance; D008954:Models, Biological; D010360:Patient Transfer; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000295:instrumentation*; D012122:Ventilators, Mechanical