Scoring System to Evaluate the Performance of ICU Ventilators in the Pandemic of COVID-19: A Lung Model Study

Abstract

Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.

Performance Evaluation of a Low-Cost Non-Invasive Ventilator during the COVID-19 Pandemic: A Bench Study

“…In severe restrictive pulmonary mechanics scenarios (i.e., COVID-19), the performance of COVIDair regarding inspiratory trigger sensitivity remains the same. With optimal setting, the inspiratory TDT was always less than 100 ms. A scoring system has been proposed to evaluate the performance of ICU ventilators in the context of the COVID-19 pandemic [ 6 ]. Even though the investigation was carried out slightly differently in the present study, the performance of the COVID air demonstrated values of inspiratory TDT (86.4 (±2.9) ms) close to the targeted best value (i.e., maximal score in the scoring system) of 60.0 ms in low compliance plus increased respiratory effort COVID-19 scenario (i.e., compliance 20 mL/cmH 2 O, respiratory rate 40 cycles/min and inspiratory effort of 10 cmH 2 O).…”

High potential of technology to face new respiratory viruses: mechanical ventilation devices for effective healthcare to next pandemic emergencies

“…In particular, mechanical ventilator is applied to patients with acute or acute-on-chronic respiratory failure that do not respond to standard therapeutic interventions, such as antibiotics, bronchodilators, etc. [ 28 , 29 ].…”