Combined effects of leaks, respiratory system properties and upper airway patency on the performance of home ventilators: a bench study

Abstract

BackgroundCombined effects of leaks, mechanical property of respiratory system and upper airway (UA) patency on patient-ventilator synchrony (PVA) and the level of clinically “tolerable” leaks are not well established in home ventilators.MethodsWe comparatively assessed on a bench model, the highest leak level tolerated without inducing significant asynchrony (“critical leak”) in three home ventilators (Astral 150, Trilogy 100 and Vivo 60; noted as A150, T100 and V60 respectively) subjected to three simulated diseased respiratory conditions: chronic obstructive pulmonary disease (COPD), obesity hypoventilation (OHS) and neuromuscular disorders (NMD), with both open and closed UA. Also, total leak values in the device reports were compared to the bench-measured values.ResultsWith open UA, all ventilators were able to avoid asynchrony up to a 30 L/min leak and even to 55 L/min in some cases. UA closure and respiratory diseases especially OHS influenced PVA. With closed UA, the critical leak of A150 and T100 remained higher than 55 L/min in COPD and OHS, while for V60 decreased to 41 and 33 L/min respectively. In NMD with closed UA, only T100 reached a high critical leak of 69 L/min. Besides, inspiratory trigger sensitivity change was often necessary to avoid PVA.ConclusionsHome ventilators were able to avoid PVA in high-level leak conditions. However, asynchrony appeared in cases of abnormal mechanical properties of respiratory system or closed UA. In case of closed UA, the EPAP should be adjusted prior to the inspiratory trigger.Trial registrationNot applicable.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0487-2) contains supplementary material, which is available to authorized users.

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome

“…studies investigating NIV leakage in a pediatric population; furthermore, the level of clinical "tolerability" of leaks is not well established in home NIV. 40 Despite this, it is widely known that large degrees of leakage will significantly affect NIV performance, as well as comfort. 41 Large air leaks can significantly reduce the level of delivered intra-alveolar pressure, indeed the response of the PAP machine can be reduced by up to 56% in the presence of a leak of 30 L/min.…”

“…Having established satisfactory compliance within our DS pediatric cohort, we next looked at another key factor of therapeutic success, effective NIV delivery, and system leakage. To date, there have been no studies investigating NIV leakage in a pediatric population; furthermore, the level of clinical “tolerability” of leaks is not well established in home NIV 40 . Despite this, it is widely known that large degrees of leakage will significantly affect NIV performance, as well as comfort 41 .…”

Double-Triggering During Noninvasive Ventilation in a Simulated Lung Model

“…With the proliferation of various NIV devices intended for both hospital and home use over the last 2 decades, much interest has focused on improving patient-ventilator interaction. 8,[18][19][20][21] Patient-ventilator asynchrony is common in NIV, with some studies suggesting a clinical prevalence of 25-50%. 8,22 In one study, 12% of breaths delivered to 53 subjects receiving invasive mechanical ventilation (for a variety of indications) showed evidence of double-triggering.…”

Análisis De Los Datos De Monitorización Del Ventilador Para La Toma De Decisiones en Ventilación Mecánica Invasiva Crónica

“…No esta tan claro el límite para hablar de una fuga exageradamente alta, se ha reportado una fuga intencional programada de aproximadamente 200ml/segundo (12 L/min) a PEEP 5. Los ventiladores Trilogy®, de acuerdo al fabricante, son capaces de compensar hasta el doble de su fuga, una fuga de hasta aproxima-damente 25 L/min podría ser tolerada, siempre considerando que debe chequearse el motivo de la fuga(12)(19) (21)(22)(23).…”