Bench studies evaluating devices for non-invasive ventilation: critical analysis and future perspectives

Olivieri, Carlo; Costa, Roberta; Conti, Giorgio; Navalesi, Paolo

doi:10.1007/s00134-011-2416-9

Cited by 67 publications

(62 citation statements)

References 35 publications

(184 reference statements)

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“…Leak is one of the most important factors affecting patient-ventilator synchrony. 97 When choosing the NIV interface, great consideration should be given to minimizing unintentional leak, 98 which impairs NIV efficiency, [99][100][101][102] particularly during the first few hours of ventilation, when the patient is adapting to NIV, and during sleep, due to the loss of voluntary muscle control and decreased muscle tone. Interventions to reduce air leak include mask-support ring; ensuring proper interface type, size, and securing system; and optimizing patient comfort and efficiency with, for instance, hydrogel or foam seal, lip seal or mouth taping, and/or chin strap.…”

Section: Tricks and Trapsmentioning

confidence: 99%

“…Ventilators specifically designed for NIV, as well as ICU ventilators with an NIV module, are designed to compensate for air leak, but there is high variability among such ventilators. 101,102 The best performance, tested both in vivo and in vitro, in patient-ventilator interaction, has been with 102 When starting NIV, the clinicians should always consider that the patient needs to maintain at least a minimal respiratory capacity. We can face 2 extremes: the first is when the patient is comatose but still able to breathe by her/himself (ie, due to the effect of severe hypercapnia); the second is when the respiratory drive is abnormally increased due to anxiety and diaphoresis.…”

Section: Tricks and Trapsmentioning

confidence: 99%

See 1 more Smart Citation

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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Section: Tricks and Trapsmentioning

confidence: 99%

Section: Tricks and Trapsmentioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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“…Four combinations of resistance and compliance were programmed into the model 11 Two study arms were conducted. First, we assessed the influence of inspiratory muscle relaxation using various combinations of lung models and ventilator settings.…”

Section: Methodsmentioning

confidence: 99%

Simulation of Late Inspiratory Rise in Airway Pressure During Pressure Support Ventilation

Lin

et al. 2014

Respir Care

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BACKGROUND: Late inspiratory rise in airway pressure (LIRAP, P aw /⌬T) caused by inspiratory muscle relaxation or expiratory muscle contraction is frequently seen during pressure support ventilation (PSV), although the modulating factors are unknown. METHODS: We investigated the effects of respiratory mechanics (normal, obstructive, restrictive, or mixed), inspiratory effort (؊2, ؊8, or ؊15 cm H 2 O), flow cycle criteria (5-40% peak inspiratory flow), and duration of inspiratory muscle relaxation (0.18 -0.3 s) on LIRAP during PSV using a lung simulator and 4 types of ventilators. RESULTS: LIRAP occurred with all lung models when inspiratory effort was medium to high and duration of inspiratory muscle relaxation was short. The normal lung model was associated with the fastest LIRAP, whereas the obstructive lung model was associated with the slowest. Unless lung mechanics were normal or mixed, LIRAP was unlikely to occur when inspiratory effort was low. Different ventilators were also associated with differences in LIRAP speed. Except for within the restrictive lung model, changes in flow cycle level did not abolish LIRAP if inspiratory effort was medium to high. Increased duration of inspiratory relaxation also led to the elimination of LIRAP. Simulation of expiratory muscle contraction revealed that LIRAP occurred only when expiratory muscle contraction occurred sometime after the beginning of inspiration. CONCLUSIONS: Our simulation study reveals that both respiratory resistance and compliance may affect LIRAP. Except for under restrictive lung conditions, LIRAP is unlikely to be abolished by simply lowering flow cycle criteria when inspiratory effort is strong and relaxation time is rapid. LIRAP may be caused by expiratory muscle contraction when it occurs during inspiration. Key words: patient-ventilator asynchrony; pressure support ventilation; late inspiratory rise in airway pressure. [Respir Care 2015;60(2):201-209.

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“…When choosing a HCV, clinicians rely on personal experience and on the results of observational trials [4,6,8,10,[12][13][14][15][16][17][18][19][20][21][22][23][24]. Ideally, the process of choosing a ventilator should be based on a strong scientific rationale founded on predetermined requisites and scores as in the critical care area [25].…”

Section: Statement Of Interestmentioning

confidence: 99%