The Experts below are selected from a list of 48999 Experts worldwide ranked by ideXlab platform
Daniel Navajas - One of the best experts on this subject based on the ideXlab platform.
-
low cost easy to build noninvasive pressure support Ventilator for under resourced regions open source hardware description performance and feasibility testing
European Respiratory Journal, 2020Co-Authors: Onintza Garmendia, Daniel Navajas, Miguel A Rodriguezlazaro, Jorge Otero, Phuong Phan, Alexandrina Stoyanova, A T Dinhxuan, David GozalAbstract:Aim Current pricing of commercial mechanical Ventilators in low/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build non-invasive bilevel pressure Ventilator to allow reducing the serious shortage of Ventilators in LMICs. Methods The Ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost Results The designed Ventilator provided inspiratory/expiratory pressures up to 20/10 cmH2O, respectively, with no faulty triggering or cycling both in the bench test and in volunteers. Breathing difficulty score rated (1–10 scale) by the loaded breathing subjects was significantly (p Conclusion The low-cost, easy-to-build non-invasive Ventilator performs similarly as a high-quality commercial device, with its open-source hardware description, will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.
-
performance of mechanical Ventilators at the patient s home a multicentre quality control study
Thorax, 2006Co-Authors: Ramon Farre, Daniel Navajas, Enric Prats, Sergi Marti, Rosa Guell, Josep M Montserrat, Cristian Tebe, Joan EscarrabillAbstract:Background: Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). Methods: A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the Ventilator control panel, and the actual performance of the Ventilator measured at home were compared; (2) the different Ventilator alarms were tested; and (3) the effect of differences between the prescribed settings and the actual performance of the Ventilator on non-programmed readmissions of the patient was determined. Results: Considerable differences were found between actual, set, and prescribed values of Ventilator variables; these differences were similar in volume and pressure preset Ventilators. The percentage of patients with a discrepancy between the prescribed and actual measured main Ventilator variable (minute ventilation or inspiratory pressure) of more than 20% and 30% was 13% and 4%, respectively. The number of Ventilators with built in alarms for power off, disconnection, or obstruction was 225, 280 and 157, respectively. These alarms did not work in two (0.9%), 52 (18.6%) and eight (5.1%) Ventilators, respectively. The number of non-programmed hospital readmissions in the year before the study did not correlate with the index of Ventilator error. Conclusions: This study illustrates the current limitations of the quality control of HMV and suggests that improvements should be made to ensure adequate Ventilator settings and correct Ventilator performance and Ventilator alarm operation.
Laurent Brochard - One of the best experts on this subject based on the ideXlab platform.
-
reliability and limits of transport Ventilators to safely ventilate severe patients in special surge situations
Annals of Intensive Care, 2020Co-Authors: Dominique Savary, Laurent Brochard, Francois Beloncle, Jeanchristophe Richard, Arnaud Lesimple, Francois Morin, F Templier, Alexandre Broc, Alain MercatAbstract:Intensive Care Units (ICU) have sometimes been overwhelmed by the surge of COVID-19 patients. Extending ICU capacity can be limited by the lack of air and oxygen pressure sources available. Transport Ventilators requiring only one O2 source may be used in such places. To evaluate the performances of four transport Ventilators and an ICU Ventilator in simulated severe respiratory conditions. Two pneumatic transport Ventilators, (Oxylog 3000, Draeger; Osiris 3, Air Liquide Medical Systems), two turbine transport Ventilators (Elisee 350, ResMed; Monnal T60, Air Liquide Medical Systems) and an ICU Ventilator (Engstrom Carestation—GE Healthcare) were evaluated on a Michigan test lung. We tested each Ventilator with different set volumes (Vtset = 350, 450, 550 ml) and compliances (20 or 50 ml/cmH2O) and a resistance of 15 cmH2O/l/s based on values described in COVID-19 Acute Respiratory Distress Syndrome. Volume error (percentage of Vtset) with P0.1 of 4 cmH2O and trigger delay during assist-control ventilation simulating spontaneous breathing activity with P0.1 of 4 cmH2O and 8 cmH2O were measured. Grouping all conditions, the volume error was 2.9 ± 2.2% for Engstrom Carestation; 3.6 ± 3.9% for Osiris 3; 2.5 ± 2.1% for Oxylog 3000; 5.4 ± 2.7% for Monnal T60 and 8.8 ± 4.8% for Elisee 350. Grouping all conditions (P0.1 of 4 cmH2O and 8 cmH2O), trigger delay was 50 ± 11 ms, 71 ± 8 ms, 132 ± 22 ms, 60 ± 12 and 67 ± 6 ms for Engstrom Carestation, Osiris 3, Oxylog 3000, Monnal T60 and Elisee 350, respectively. In surge situations such as COVID-19 pandemic, transport Ventilators may be used to accurately control delivered volumes in locations, where only oxygen pressure supply is available. Performances regarding triggering function are acceptable for three out of the four transport Ventilators tested.
-
reliability and limits of transport Ventilators to safely ventilate severe patients in special surge situations
medRxiv, 2020Co-Authors: Dominique Savary, Laurent Brochard, Francois Beloncle, Jeanchristophe Richard, Arnaud Lesimple, Francois Morin, F Templier, Alexandre Broc, Alain MercatAbstract:BackgroundSeveral Intensive Care Units (ICU) have been overwhelmed by the surge of COVID-19 patients thus necessitating to extend ventilation capacity outside the ICU where air and oxygen pressure are not always available. Transport Ventilators requiring only O2 source may be used to deliver volume-controlled ventilation. ObjectiveTo evaluate the performances of four transport Ventilators compared to an ICU Ventilator simulating severe respiratory conditions. Materials and methodsTwo pneumatic transport Ventilators, (Oxylog 3000, Draeger; Osiris 3, Air Liquide Medical Systems) and two turbine transport Ventilators (Elisee 350, ResMed; Monnal T60, Air Liquide Medical Systems) were compared to an ICU Ventilator (Engstrom Carestation - GE Healthcare) using a Michigan training test lung. We tested each Ventilator with different set volumes Vtset (350, 450, 550 ml) and different compliances (20 or 50 ml/cmH2O) and a resistance of 15 cmH2 0/L/sec based on values recently described in COVID-19 Acute Respiratory Distress Syndrome. Volume error was measured, as well as the trigger time delay during assist-control ventilation simulating spontaneous breathing activity with a P0.1 of 4 cmH20. ResultsGrouping all conditions, the volume error was 2.9 {+/-} 2.2 % for Engstrom Carestation; 3.6 {+/-} 3.9 % for Osiris 3; 2.5 {+/-} 2.1 % for Oxylog 3000; 5.4 {+/-} 2.7 % for Monnal T60 and 8.8 {+/-} 4.8 % for Elisee 350. Grouping all conditions, trigger delay was 42 {+/-} 4 ms, 65 {+/-} 5 ms, 151 {+/-} 14 ms, 51 {+/-} 6 and 64 {+/-} 5 ms for Engstrom Carestation, Osiris 3, Oxylog 3000, Monnal T60 and Elisee 350, respectively. ConclusionsIn special surge situations such as COVID-19 pandemic, most transport Ventilators may be used to safely deliver volume-controlled ventilation in locations where only oxygen pressure supply is available with acceptable volume accuracy. Performances regarding triggering function are generally acceptable but vary across Ventilators.
-
comparison between neurally adjusted Ventilatory assist and pressure support ventilation levels in terms of respiratory effort
Critical Care Medicine, 2016Co-Authors: Guillaume Carteaux, Aissam Lyazidi, Ana Cordobaizquierdo, Arnaud W Thille, Leo M A Heunks, Laurent BrochardAbstract:Objectives: To understand the potential equivalence between neurally adjusted Ventilatory assist and pressure support ventilation levels in terms of respiratory muscle unloading. To compare the respiratory pattern, variability, synchronization, and neuromuscular coupling within comparable ranges of assistance. Design: Prospective single-center physiologic study. Setting: A 13-bed university medical ICU. Patients: Eleven patients recovering from respiratory failure. Interventions: The following levels of assistance were consecutively applied in a random order: neurally adjusted Ventilatory assist levels: 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, and 7 cm H2O/μvolt; pressure support levels: 7, 10, 15, 20, and 25 cm H2O. Measurements and Main Results: Flow, airway pressure, esophageal pressures, and peak electrical activity of the diaphragm were continuously recorded. Breathing effort was calculated. To express the percentage of assist assumed by the Ventilator, the total pressure including muscular and Ventilator pressure was calculated. The median percentage of assist ranged from 33% (24–47%) to 82% (72–90%) between pressure support 7 and 25 cm H2O. Similar levels of unloading were observed for neurally adjusted Ventilatory assist levels from 0.5 cm H2O/μvolt (46% [40–51%]) to 2.5 cm H2O/μvolt (80% [74–84%]). Tidal variability was higher during neurally adjusted Ventilatory assist and ineffective efforts appeared only in pressure support. In neurally adjusted Ventilatory assist, double triggering occurred sometimes when electrical activity of the diaphragm signal depicted a biphasic aspect, and an abnormal oscillatory pattern was frequently observed from 4 cm H2O/μvolt. For both modes, the relationship between peak electrical activity of the diaphragm and muscle pressure depicted a curvilinear profile. Conclusions: In patients recovering from acute respiratory failure, levels of neurally adjusted Ventilatory assist between 0.5 and 2.5 cm H2O/μvolt are comparable to pressure support levels ranging from 7 to 25 cm H2O in terms of respiratory muscle unloading. Neurally adjusted Ventilatory assist provides better patient-Ventilator interactions but can be sometimes excessively sensitive to electrical activity of the diaphragm in terms of triggering.
-
sleep in hypercapnic critical care patients under noninvasive ventilation conventional versus dedicated Ventilators
Critical Care Medicine, 2013Co-Authors: Ana Cordobaizquierdo, Arnaud W Thille, Fabrice Galia, Xavier Drouot, Ferran Rochecampo, Frederique Schortgen, Enric Pratssoro, Laurent BrochardAbstract:OBJECTIVE To compare sleep quality between two types of Ventilators commonly used for noninvasive ventilation: conventional ICU Ventilators and dedicated noninvasive Ventilators; and to evaluate sleep during and between noninvasive ventilation sessions in critically ill patients. DESIGN Physiological sleep study with a randomized assessment of the Ventilator type. SETTING Medical ICU in a university hospital. PATIENTS Twenty-four patients admitted for acute hypercapnic respiratory failure requiring noninvasive ventilation. INTERVENTIONS Patients were randomly assigned to receive noninvasive ventilation with either an ICU Ventilators (n = 12) or a dedicated noninvasive Ventilators (n = 12), and their sleep and respiratory parameters were recorded by polysomnography from 4 PM to 9 AM on the second, third, or fourth day after noninvasive ventilation initiation. MEASUREMENTS AND MAIN RESULTS Sleep architecture was similar between Ventilator groups, including sleep fragmentation (number of arousals and awakenings/hr), but the dedicated noninvasive Ventilators group showed a higher patient-Ventilator asynchrony-related fragmentation (28% [17-44] vs. 14% [7.0-22]; p = 0.02), whereas the ICU Ventilators group exhibited a higher noise-related fragmentation. Ineffective efforts were more frequent in the dedicated noninvasive Ventilators group than in the ICU Ventilators group (34 ineffective efforts/hr of sleep [15-125] vs. two [0-13]; p < 0.01), possibly as a result of a higher tidal volume (7.2 mL/kg [6.7-8.8] vs. 5.8 [5.1-6.8]; p = 0.04). More sleep time occurred and sleep quality was better during noninvasive ventilation sessions than during spontaneous breathing periods (p < 0.05) as a result of greater slow wave and rapid eye movement sleep and lower fragmentation. CONCLUSIONS There were no observed differences in sleep quality corresponding to the type of Ventilator used despite slight differences in patient-Ventilator asynchrony. Noninvasive ventilation sessions did not prevent patients from sleeping; on the contrary, they seem to aid sleep when compared with unassisted breathing.
-
patient Ventilator asynchrony during noninvasive ventilation a bench and clinical study
Chest, 2012Co-Authors: Guillaume Carteaux, Laurent Brochard, Aissam Lyazidi, Ana Cordobaizquierdo, Laurence Vignaux, Philippe Jolliet, Arnaud W Thille, Jeanchristophe M RichardAbstract:Background Different kinds of Ventilators are available to perform noninvasive ventilation (NIV) in ICUs. Which type allows the best patient-Ventilator synchrony is unknown. The objective was to compare patient-Ventilator synchrony during NIV between ICU, transport—both with and without the NIV algorithm engaged—and dedicated NIV Ventilators. Methods First, a bench model simulating spontaneous breathing efforts was used to assess the respective impact of inspiratory and expiratory leaks on cycling and triggering functions in 19 Ventilators. Second, a clinical study evaluated the incidence of patient-Ventilator asynchronies in 15 patients during three randomized, consecutive, 20-min periods of NIV using an ICU Ventilator with and without its NIV algorithm engaged and a dedicated NIV Ventilator. Patient-Ventilator asynchrony was assessed using flow, airway pressure, and respiratory muscles surface electromyogram recordings. Results On the bench, frequent auto-triggering and delayed cycling occurred in the presence of leaks using ICU and transport Ventilators. NIV algorithms unevenly minimized these asynchronies, whereas no asynchrony was observed with the dedicated NIV Ventilators in all except one. These results were reproduced during the clinical study: The asynchrony index was significantly lower with a dedicated NIV Ventilator than with ICU Ventilators without or with their NIV algorithm engaged (0.5% [0.4%-1.2%] vs 3.7% [1.4%-10.3%] and 2.0% [1.5%-6.6%], P Conclusions Dedicated NIV Ventilators allow better patient-Ventilator synchrony than ICU and transport Ventilators, even with their NIV algorithm. However, the NIV algorithm improves, at least slightly and with a wide variation among Ventilators, triggering and/or cycling off synchronization.
Claude Guerin - One of the best experts on this subject based on the ideXlab platform.
-
neurally adjusted Ventilatory assist as an alternative to pressure support ventilation in adults a french multicentre randomized trial
Intensive Care Medicine, 2016Co-Authors: Alexandre Demoule, Hadrien Roze, Marc Clavel, C Rollanddebord, Sebastien Perbet, Nicolas Terzi, Achille Kouatchet, Frederic Wallet, Frederic Vargas, Claude GuerinAbstract:Purpose Neurally adjusted Ventilatory assist (NAVA) is a Ventilatory mode that tailors the level of assistance delivered by the Ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation.
-
neurally adjusted Ventilatory assist as an alternative to pressure support ventilation in adults a french multicentre randomized trial
Intensive Care Medicine, 2016Co-Authors: Alexandre Demoule, Hadrien Roze, Marc Clavel, C Rollanddebord, Sebastien Perbet, Nicolas Terzi, Achille Kouatchet, Frederic Wallet, Frederic Vargas, Claude GuerinAbstract:Purpose: Neurally adjusted Ventilatory assist (NAVA) is a Ventilatory mode that tailors the level of assistance delivered by the Ventilator to the electromyographic activity of the diaphragm. The objective of this study was to compare NAVA and pressure support ventilation (PSV) in the early phase of weaning from mechanical ventilation. Methods: A multicentre randomized controlled trial of 128 intubated adults recovering from acute respiratory failure was conducted in 11 intensive care units. Patients were randomly assigned to NAVA or PSV. The primary outcome was the probability of remaining in a partial Ventilatory mode (either NAVA or PSV) throughout the first 48 h without any return to assist-control ventilation. Secondary outcomes included asynchrony index, Ventilator-free days and mortality. Results: In the NAVA and PSV groups respectively, the proportion of patients remaining in partial Ventilatory mode throughout the first 48 h was 67.2 vs. 63.3 % (P = 0.66), the asynchrony index was 14.7 vs. 26.7 % (P < 0.001), the Ventilator-free days at day 7 were 1.0 day [1.0–4.0] vs. 0.0 days [0.0–1.0] (P < 0.01), the Ventilator-free days at day 28 were 21 days [4–25] vs. 17 days [0–23] (P = 0.12), the day-28 mortality rate was 15.0 vs. 22.7 % (P = 0.21) and the rate of use of post-extubation noninvasive mechanical ventilation was 43.5 vs. 66.6 % (P < 0.01). Conclusions: NAVA is safe and feasible over a prolonged period of time but does not increase the probability of remaining in a partial Ventilatory mode. However, NAVA decreases patient–Ventilator asynchrony and is associated with less frequent application of post-extubation noninvasive mechanical ventilation.
Jorge Otero - One of the best experts on this subject based on the ideXlab platform.
-
low cost easy to build noninvasive pressure support Ventilator for under resourced regions open source hardware description performance and feasibility testing
European Respiratory Journal, 2020Co-Authors: Onintza Garmendia, Daniel Navajas, Miguel A Rodriguezlazaro, Jorge Otero, Phuong Phan, Alexandrina Stoyanova, A T Dinhxuan, David GozalAbstract:Aim Current pricing of commercial mechanical Ventilators in low/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build non-invasive bilevel pressure Ventilator to allow reducing the serious shortage of Ventilators in LMICs. Methods The Ventilator was built using off-the-shelf materials available via e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost Results The designed Ventilator provided inspiratory/expiratory pressures up to 20/10 cmH2O, respectively, with no faulty triggering or cycling both in the bench test and in volunteers. Breathing difficulty score rated (1–10 scale) by the loaded breathing subjects was significantly (p Conclusion The low-cost, easy-to-build non-invasive Ventilator performs similarly as a high-quality commercial device, with its open-source hardware description, will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.
Robert M. Kacmarek - One of the best experts on this subject based on the ideXlab platform.
-
bench evaluation of two bag squeezer disaster Ventilators
Respiratory Care, 2020Co-Authors: Esther H Chung, Carolyn J La Vita, Lorenzo Berra, Caio C A Morais, Keith A Marill, Aaron D Aguirre, Robert M. KacmarekAbstract:Background: The COVID-19 pandemic of 2020 created concern regarding the preparedness of the US Health Care System. One major concern was the availability of mechanical Ventilators. Consequently, the US government and many state and local health care systems called upon manufacturers of existing mechanical Ventilators as well as entrepreneurs, innovators, and scientists to rapidly manufacture or develop devices to provide assisted ventilation. The Partners HealthCare System developed an Innovation center with one group devoted to Ventilator innovation that met regularly. We present here the results of our evaluation of 2 of two “bag squeezer” types Ventilators. Methods: We evaluated the performance of near final prototypes of the RISE and a version of the MIT “bag Squeezer” type Ventilators using the Michigan Instruments TTL adult patient lung simulator. A NICO respiratory monitor (Philips) was used to assess the difference between Ventilator settings and actual delivered gas volume. The primary outcome was the ability of each Ventilator to perform to its specification, and secondary outcomes included alarm system response. Each device was tested through the same range of specified ventilation and lung simulator conditions. A greater than 10% deviation of actual delivered from device set parameter in a given setting was considered unacceptable. Results: Neither the MIT nor RISE Ventilator were able to perform to their specification. Both were unable to maintain delivery of set tidal volume as respiratory rate and inspiratory time were varied (Figure 1a and 1b). However, both performed best when the compliance was 50 mL/cm H2O and the resistance 5 cm H2O/ L/s. Specifically, the MIT Ventilator was unable to provide the set tidal volume in 86% of the respiratory rate trials (1a) while the RISE Ventilator was unable to provide the set tidal volume 75% of the time (1b). Similar finding occurred with inspiratory time variation vs. set tidal (79% vs, 82% respectively MIT then RISE). Alarms inappropriately sounded in 100% of trials with MIT Ventilators and 66% of trials with the RISE Ventilator, with numerous alarms sounding unrelated to the clinical condition tested. However, it should be remembered that these Ventilators were developed over 4 to 6 weeks. Conclusions: These Ventilators were unable to meet specification. This data was provided to the manufacturers. Before these type Ventilators are put into use their performance should be carefully evaluated.
-
neonatal invasive pressure support ventilation a comparison of new generation adult icu Ventilators
Respiratory Care, 2019Co-Authors: Carolyn J La Vita, Beverly Ejiofor, Esther H Chung, Robert M. KacmarekAbstract:Background: Essentially all new generation adult ICU Ventilators are designed to provide ventilation of neonates to adults. Nihon Kohden recently introduced a new Ventilator to the market the NKV 500. To determine the performance of this Ventilator during neonatal pressure support it needs to be compared to established ICU Ventilators. In this study we compared the gas delivery capabilities of the new Nihon Kohden 550 Ventilator (NKV 550) to that of the Medtronic PB980 and the Drager V500 Ventilators. We hypothesized that if these Ventilators were optimally set in pressure support ventilation there would be no differences in trigger response, pressurization time and volume delivery. Methods: Evaluations were performed with the IngMar ASL 5000 computerized lung simulator using a dry circuit and the Fisher & Paykel RT260 neonatal Ventilator circuit. The ASL 5000 was set to simulate neonatal lung mechanics with a weak, normal and strong Ventilatory drive (P0.1 1, 4.2 and 7.3 cm H2O) and inspiratory time varying from 250 to 400 milliseconds (ms). Evaluations were performed without a leak and with a leak (1 to 1.5 L/min). Ventilator trigger sensitivity, rise time and termination criteria were optimally set. Each Ventilator was set to deliver 5/5, 10/5 and 15/10 cm H2O pressure support above PEEP. A total of 18 trials were conducted on each Ventilator. Each trial lasted 2 min. The last 10 breath of each trial were analyzed. Trigger time (TT, ms), max pressure to trigger (MaxTrigP, cm H2O), time to max trigger pressure (T-Tpress, ms), trigger pressure time product (PTP, cm H2O -ms), time to 90% of peak pressure (T90, ms), and tidal volume (VT, mL) were compared among Ventilators using ANOVA for repeated measures. Potentially important clinical differences were defined as a P 10% difference among Ventilators. Results: The only potentially clinically important difference identified among variables evaluated was maximum trigger pressure(see table). Even this difference, although it met our criteria (P 10%), is small (-0.23 vs -0.28 cm H2O across Ventilators) and unlikely clinically important. Conclusions: The NKV500, PB980 and V500 all performed similarly during this evaluation. The only potentially important difference was maximum trigger pressure. Disclosures: Robert Kacmarek is a consultant for Medtronic’s and Orange Medical and has received research grants from Medtronic’s and Venner Medical. All other authors report no conflict of interest
-
gas delivery during adult patient triggered mechanical ventilation in new generation icu Ventilators
Respiratory Care, 2019Co-Authors: Carolyn J La Vita, Beverly Ejiofor, Esther H Chung, Robert M. KacmarekAbstract:Background: New generation ICU Ventilators frequently enter the market. To determine the performance of these Ventilators they need to be compared to established ICU Ventilators. In this study we compared the gas delivery capabilities of the new Nihon Kohden 550 Ventilator (NKV 550) to that of the Medtronic PB980 and the Drager V500 Ventilators. We hypothesized that if these Ventilators were optimally set in pressure support ventilation there would be no differences in trigger response, pressurization time and volume delivery. Methods: Evaluations were performed with the IngMar ASL 5000 computerized lung simulator using a dry circuit and the Fisher & Paykel RT380 adult Ventilator circuit. The ASL 5000 was set to simulate normal, COPD and ARDS lung mechanics with two Ventilatory drives 1.7 and 6.7 cm H2O and inspiratory times varying from 500 to 900 milliseconds, ms. Ventilator trigger sensitivity, rise time and termination criteria were optimally set. Each Ventilator was set to deliver 5/5, 10/5 and 15/10 cm H2O pressure support above PEEP. A total of 18 trials were conducted on each Ventilator. Each trial lasted 2 min. The last 10 breath of each trial were analyzed. Trigger time (TT, ms), max pressure to trigger (MaxTrigP, cm H2O), time to max trigger pressure (T-Tpress, ms), trigger pressure time product (PTP, cm H2O -ms) time to 90% of peak pressure (T90, ms), and tidal volume (VT, mL) were compared among Ventilators using ANOVA for repeated measures. Potentially important clinical differences were defined as a P 10% difference among Ventilators. Results: Potentially clinically important differences were identified among all variables except tidal volume(see table). Variables differed among Ventilators with a P 10% difference except for tidal volume. These differences were a result of increased time to trigger during COPD lung mechanics and a low Ventilatory drive. Both independently increased time to trigger (data not shown). Conclusions: There are clinically important difference in the performance of the NKV 500, PB 980 and V500 Ventilators during adult pressure support ventilation. Disclosures: Robert Kacmarek is a consultant for Medtronic’s and Orange Medical and has received research grants from Medtronic’s and Venner Medical. All other authors report no conflict of interest
-
are we fully utilizing the functionalities of modern operating room Ventilators
Current Opinion in Anesthesiology, 2017Co-Authors: Shujie Liu, Robert M. Kacmarek, Jun OtoAbstract:Purpose of review The modern operating room Ventilators have become very sophisticated and many of their features are comparable with those of an ICU Ventilator. To fully utilize the functionality of modern operating room Ventilators, it is important for clinicians to understand in depth the working principle of these Ventilators and their functionalities. Recent findings Piston Ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine Ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-based ventilation modes provide better leak compensation than volume-based. The integration of advanced flow generation systems and ventilation modes of the modern operating room Ventilators enables clinicians to provide both invasive and noninvasive ventilation in perioperative settings. Ventilator waveforms can be used for intraoperative neuromonitoring during cervical spine surgery. Summary The increase in number of new features of modern operating room Ventilators clearly creates the opportunity for clinicians to optimize Ventilatory care. However, improving the quality of Ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.
-
trigger performance of mid level icu mechanical Ventilators during assisted ventilation a bench study
Intensive Care Medicine, 2008Co-Authors: Daniel W Chipman, Juliana Carvalho Ferreira, Robert M. KacmarekAbstract:To compare the triggering performance of mid-level ICU mechanical Ventilators with a standard ICU mechanical Ventilator. Experimental bench study. The respiratory care laboratory of a university-affiliated teaching hospital. A computerized mechanical lung model, the IngMar ASL5000. Ten mid-level ICU Ventilators were compared to an ICU Ventilator at two levels of lung model effort, three combinations of respiratory mechanics (normal, COPD and ARDS) and two modes of ventilation, volume and pressure assist/control. A total of 12 conditions were compared. Performance varied widely among Ventilators. Mean inspiratory trigger time was <100 ms for only half of the tested Ventilators. The mean inspiratory delay time (time from initiation of the breath to return of airway pressure to baseline) was longer than that for the ICU Ventilator for all tested Ventilators except one. The pressure drop during triggering (Ptrig) was comparable with that of the ICU Ventilator for only two Ventilators. Expiratory Settling Time (time for pressure to return to baseline) had the greatest variability among Ventilators. Triggering differences among these mid-level ICU Ventilators and with the ICU Ventilator were identified. Some of these Ventilators had a much poorer triggering response with high inspiratory effort than the ICU Ventilator. These Ventilators do not perform as well as ICU Ventilators in patients with high Ventilatory demand.
