Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators.
Non-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or 'rainout' from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.



To assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.



Seven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH2O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.



Several ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H2O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from 'specific' (tube occluded) to 'ambiguous' (Safety valve open). Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH2O compared to the measured values of 13cmH2O.



This study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.|Sydney University, Sydney, New South Wales, Australia.
Murray
M
Hinder
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.
Aldo
A
Perdomo
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.|Department of Paediatrics and Child Health Sydney University, Sydney, New South Wales, Australia.
Mark
M
Tracy
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004868:Equipment Failure; D006801:Humans; D007231:Infant, Newborn; D012121:Respiration, Artificial / Q000295:instrumentation*; D012637:Security Measures; D014867:Water
D014867:Water