Bilevel vs ICU ventilators providing noninvasive ventilation: effect of system leaks: a COPD lung model comparison.
BACKGROUND
Noninvasive positive-pressure ventilation (NPPV) modes are currently available on bilevel and ICU ventilators. However, little data comparing the performance of the NPPV modes on these ventilators are available.


METHODS
In an experimental bench study, the ability of nine ICU ventilators to function in the presence of leaks was compared with a bilevel ventilator using the IngMar ASL5000 lung simulator (IngMar Medical; Pittsburgh, PA) set at a compliance of 60 mL/cm H(2)O, an inspiratory resistance of 10 cm H(2)O/L/s, an expiratory resistance of 20 cm H(2)O/ L/s, and a respiratory rate of 15 breaths/min. All of the ventilators were set at 12 cm H(2)O pressure support and 5 cm H(2)O positive end-expiratory pressure. The data were collected at baseline and at three customized leaks.


RESULTS
At baseline, all of the ventilators were able to deliver adequate tidal volumes, to maintain airway pressure, and to synchronize with the simulator, without missed efforts or auto-triggering. As the leak was increased, all of the ventilators (except the Vision [Respironics; Murrysville, PA] and Servo I [Maquet; Solna, Sweden]) needed adjustment of sensitivity or cycling criteria to maintain adequate ventilation, and some transitioned to backup ventilation. Significant differences in triggering and cycling were observed between the Servo I and the Vision ventilators.


CONCLUSIONS
The Vision and Servo I were the only ventilators that required no adjustments as they adapted to increasing leaks. There were differences in performance between these two ventilators, although the clinical significance of these differences is unclear. Clinicians should be aware that in the presence of leaks, most ICU ventilators require adjustments to maintain an adequate tidal volume.
Departments of Anesthesia and Critical Care, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil; Instituto do Coração, Sao Paulo, Brazil.
Juliana C
JC
Ferreira
Respiratory Care, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
Daniel W
DW
Chipman
Tufts University School of Medicine, Boston, MA.
Nicholas S
NS
Hill
Respiratory Care, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil; Harvard Medical School, Boston, MA. Electronic address: rkacmarek@partners.org.
Robert M
RM
Kacmarek
D004867:Equipment Design; D004868:Equipment Failure; D004869:Equipment Safety; D006801:Humans; D007362:Intensive Care Units; D008953:Models, Anatomic; D011175:Positive-Pressure Respiration / Q000379:methods*; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D015656:Respiratory Mechanics; D012122:Ventilators, Mechanical / Q000592:standards* / Q000639:trends