Background SARS-CoV-2 aerosolization during noninvasive positive pressure ventilation may endanger healthcare professionals. Various circuit setups have been described in order to reduce virus aerosolization. However, these setups may alter ventilator performances. Research question What are the consequences of the different suggested circuit setups on ventilator’s efficacy during continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV)? Study Design and Method Eight circuit setups were evaluated on a bench made of a 3-D printed head and an artificial lung. Setups were a dual-limb circuit with an oro-nasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding trigger of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume (V t ) generated to the artificial lung, the total work of breathing (WOB) and the pressure time product to trigger the ventilator (PTPt). Results With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding the trigger of the ventilator (p<0.0001), the inspiratory effort required to trigger the ventilator (p<0.0001), the triggering delay (p<0.0001); the maximal inspiratory pressure (p<0.0001), the V t (p:0.0008), the WOB (p<0.0001), the PTPt (p<0.0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved using a dual limb circuit with an oro-nasal mask. Worst performance was achieved using a dual-limb circuit with a helmet interface. Interpretation Ventilator performance is significantly impacted by the circuit setup. The use of dual-limb circuit with oro-nasal masks should be used preferentially.
Background and objective: When home non-invasive ventilation (NIV) is initiated, five goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, health-related quality of life (HRQL) and sleep quality without side effects. Our aim was to assess how frequently these five goals were reached and the factors predictive of achievement. Methods: We conducted a monocentric cohort study that included patients electively established on home NIV over 2 years. HRQL was assessed at baseline and follow-up by the Severe Respiratory Insufficiency questionnaire. Adequate initiation was defined as the achievement of at least three of five goals and successful initiation as the achievement of all. Results: Two-hundred and fifty patients were included at baseline. NIV was initiated for: obesity hypoventilation syndrome (n = 95; 38%), neuromuscular disease (n = 70; 28%), chronic obstructive pulmonary disease (n = 66; 26%) and chest wall disease (n = 19; 8%). At follow-up, measures of all five goals were available in 141 (56%) patients. NIV initiation was adequate for 96 (68%) patients and successful for 12 (9%) patients. In multivariate analysis, a tidal volume ≥ 7.8 ml/kg of ideal body weight was associated with an increased likelihood of adequate NIV initiation (hazard ratio: 5.765 [95% CI:1.824-18.223], p = 0.006]. Improvement in daytime partial arterial carbon dioxide pressure (PaCO 2 ) was not correlated to improvement in HRQL or sleep quality. Severe to very severe NIV-related side effects occurred in 114 (47%) patients and were associated with higher daytime PaCO 2 (6.35 AE 1.08 vs. 5.92 AE 0.79 kPa, p < 0.001). Conclusion: Successful home NIV initiation is rarely achieved in real life. HRQL and NIV tolerance should be assessed to improve patient-centred outcomes.
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