title: [Monitoring tidal volumes when using the Ventrain® emergency ventilator].
abstract: BACKGROUND
  The Ventrain® emergency ventilation device allows active inspiration and expiration through transtracheal catheters or the lumen of an airway exchange catheter. This single-use handheld device is manually operated and driven by an external pressurized oxygen source. The Ventrain® may be used to ventilate patients with a complete or pending upper airway obstruction reducing the risk of barotrauma due to the possibility of active expiration. However tidal volumes (V T) applied and withdrawn with the Ventrain® can only be controlled by visual inspection of chest movements; V T monitoring is not provided. Excessive inspiratory volumes or air trapping due to insufficient expiration may remain clinically undetected until pulmonary trauma and/or cardio-respiratory deterioration occur. Active expiration itself carries the risk of overwhelming lung deflation with the formation of atelectasis. Thus, an inspiratory and expiratory tidal volume monitor is urgently required. The aim of this study was to evaluate efficacy and precision of the Florian respiratory function monitor (RFM) to monitor in- and expiratory V T administered by the Ventrain® emergency ventilation device through a small cannula to the ASL 5000 test lung (ASL).
  
  
  METHODS
  In an in-vitro setting the RFM was used with its neonatal flow sensor to monitor inspiratory and expiratory V T applied by the Ventrain® emergency ventilation device through a 2 mm internal diameter (ID) transtracheal catheter to the ASL. Driving flows of 6, 9, 12 and 15 l min(-1) were chosen to vary tidal volumes at a constant respiratory rate of 15 min(-1) and an I:E ratio of 1:1. Experiments were repeated five times with two flow sensors. An initial set-up calibration run was performed to calculate a bias correction factor for inspiratory and expiratory V T measured by the RFM. This bias correction factor was used to simulate a correction of the in the RFM programmed linearization table. In a second, identical setting the experiments were repeated five times with two flow sensors. V T measured by the adjusted RFM were compared with those obtained from the ASL 5000 in this second run and the percentage differences were calculated. Bland Altman analysis was used to investigate the agreement of inspiratory or expiratory VT measured by both methods (ASL and RFM). Calculation of the mean of differences between both methods is given as bias and the 95 % agreement interval as precision.
  
  
  RESULTS
  Tidal volumes measured by the ASL ranged from 140 to 675 ml. The percentage correction factor was 16.27 % (2.60 %) during inspiration for V T ranged from 0 to 700 ml and 11.51 % (2.56 %) during expiration for V T of 0 to 225 ml, 7.41 % (2.94 %) for VT 226 to 325 ml and 5.35 % (3.57 %) for TV e > 325 ml. Inspiratory and expiratory tidal volumes measured by the adjusted RFM demonstrated a percentage deviation (mean [SD]) of 2.59 % (1.86 %) during inspiration and 1.66 % (1.14 %) during expiration when compared with the ASL 5000. Bias (precision) of the Bland Altman plot for the adjusted RFM is 2.05 ml (23.20) during inspiration and 4.62 ml (10.40) for expiration.
  
  
  CONCLUSIONS
  The tested respiratory function monitor using hot-wire anemometer technology has the potential to monitor tidal volumes applied by the Ventrain®. With the software thus adapted, the RFM measures precise inspiratory and expiratory tidal volumes within common technical tolerance. This could help perform adequate patient ventilation with Ventrain® and reduce the potential risk of patient trauma.
authors.affiliation: Anästhesie-Abteilung, Universitäts-Kinderspital Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz. alexander.schmidt@kispi.uzh.ch.|Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich, Zürich, Schweiz. alexander.schmidt@kispi.uzh.ch.
authors.forename: A R
authors.initials: AR
authors.lastname: Schmidt
authors.affiliation: Institut für Anästhesie, Universitätsspital Zürich, Zürich, Schweiz.|Department of General Anesthesiology und Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ruetzler
authors.affiliation: Anästhesie-Abteilung, Universitäts-Kinderspital Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz.|Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich, Zürich, Schweiz.
authors.forename: T
authors.initials: T
authors.lastname: Haas
authors.affiliation: Anästhesie-Abteilung, Universitäts-Kinderspital Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz.|Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich, Zürich, Schweiz.
authors.forename: A
authors.initials: A
authors.lastname: Schmitz
authors.affiliation: Anästhesie-Abteilung, Universitäts-Kinderspital Zürich, Steinwiesstrasse 75, 8032, Zürich, Schweiz.|Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich, Zürich, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D061214:Patient Safety; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000379:methods*; D013147:Spirometry; D013990:Tidal Volume; D012122:Ventilators, Mechanical
keywords: Emergency ventilation; Monitoring; Patient safety; Spirometry; Ventrain®