Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study
Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurre...
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| Veröffentlicht in: | Respiratory care 2017-01, Vol.62 (1), p.10-21 |
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| creator | Itagaki, Taiga Bennett, Desmond J Chenelle, Christopher T Fisher, Daniel F Kacmarek, Robert M |
| description | Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently.
Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (V
) before and after the change in leak was assessed.
The differences in delivered V
between before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline V
was ≥10% greater than set V
during PC-CSV, and delivered V
markedly changed with leak. The Avea demonstrated persistent high V
in all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV.
The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted V
. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation. |
| doi_str_mv | 10.4187/respcare.05012 |
| format | Article |
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Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (V
) before and after the change in leak was assessed.
The differences in delivered V
between before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline V
was ≥10% greater than set V
during PC-CSV, and delivered V
markedly changed with leak. The Avea demonstrated persistent high V
in all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV.
The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted V
. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.</description><identifier>ISSN: 0020-1324</identifier><identifier>EISSN: 1943-3654</identifier><identifier>DOI: 10.4187/respcare.05012</identifier><identifier>PMID: 27879380</identifier><language>eng</language><publisher>United States: Daedalus Enterprises, Inc</publisher><subject>Birth weight, Low ; Computer Simulation ; Equipment Failure ; Health aspects ; Humans ; Infant, Newborn ; Infants (Newborn) ; Intensive Care Units ; Lung - physiology ; Manikins ; Models, Biological ; Respiration, Artificial - instrumentation ; Tidal Volume ; Ventilation ; Ventilators, Mechanical</subject><ispartof>Respiratory care, 2017-01, Vol.62 (1), p.10-21</ispartof><rights>Copyright © 2017 by Daedalus Enterprises.</rights><rights>COPYRIGHT 2017 Daedalus Enterprises, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-12b8508b3f9e720b0e1f6244533b2916a17d77557be4d8896e2f2946aedcbc933</citedby><cites>FETCH-LOGICAL-c433t-12b8508b3f9e720b0e1f6244533b2916a17d77557be4d8896e2f2946aedcbc933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27879380$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Itagaki, Taiga</creatorcontrib><creatorcontrib>Bennett, Desmond J</creatorcontrib><creatorcontrib>Chenelle, Christopher T</creatorcontrib><creatorcontrib>Fisher, Daniel F</creatorcontrib><creatorcontrib>Kacmarek, Robert M</creatorcontrib><title>Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study</title><title>Respiratory care</title><addtitle>Respir Care</addtitle><description>Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently.
Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (V
) before and after the change in leak was assessed.
The differences in delivered V
between before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline V
was ≥10% greater than set V
during PC-CSV, and delivered V
markedly changed with leak. The Avea demonstrated persistent high V
in all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV.
The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted V
. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.</description><subject>Birth weight, Low</subject><subject>Computer Simulation</subject><subject>Equipment Failure</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infants (Newborn)</subject><subject>Intensive Care Units</subject><subject>Lung - physiology</subject><subject>Manikins</subject><subject>Models, Biological</subject><subject>Respiration, Artificial - instrumentation</subject><subject>Tidal Volume</subject><subject>Ventilation</subject><subject>Ventilators, Mechanical</subject><issn>0020-1324</issn><issn>1943-3654</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkctr3DAQxkVpaTZprz0WQaHk4q1etqzezPYV2D6gSa5Ctkcbt7K0leRD6D9fbfOghTCHYYbf98HMh9ALStaCtvJNhLQfTIQ1qQllj9CKKsEr3tTiMVoRwkhFORNH6DilH2VsRK2eoiMmW6l4S1bo9zeINsTZ-AFwsHgL5ifehHkPPpk8BY8njzvnqm4H-GxzgS_B58mZHGLC75Y4-R2-DG6ZoTo3cQcZRvwFgjfZuHu22LzFHd4uBf4cRnD4e17G62foiTUuwfPbfoIuPrw_33yqtl8_nm26bTUIznNFWd_WpO25VSAZ6QlQ2zAhas57pmhjqBylrGvZgxjbVjXALFOiMTAO_aA4P0GnN777GH4tkLKepzSAc8ZDWJKmreCKStqQgr66QXfGgZ68DTma4YDrTkgpGlKwQq0foEqNME9D8GCnsv9P8PofwRUYl69S-drhM-lB5yGGlCJYvY_TbOK1pkQfAtd3geu_gRfBy9vbln6G8R6_S5j_AX8BpcQ</recordid><startdate>201701</startdate><enddate>201701</enddate><creator>Itagaki, Taiga</creator><creator>Bennett, Desmond J</creator><creator>Chenelle, Christopher T</creator><creator>Fisher, Daniel F</creator><creator>Kacmarek, Robert M</creator><general>Daedalus Enterprises, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201701</creationdate><title>Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study</title><author>Itagaki, Taiga ; Bennett, Desmond J ; Chenelle, Christopher T ; Fisher, Daniel F ; Kacmarek, Robert M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-12b8508b3f9e720b0e1f6244533b2916a17d77557be4d8896e2f2946aedcbc933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Birth weight, Low</topic><topic>Computer Simulation</topic><topic>Equipment Failure</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infants (Newborn)</topic><topic>Intensive Care Units</topic><topic>Lung - physiology</topic><topic>Manikins</topic><topic>Models, Biological</topic><topic>Respiration, Artificial - instrumentation</topic><topic>Tidal Volume</topic><topic>Ventilation</topic><topic>Ventilators, Mechanical</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Itagaki, Taiga</creatorcontrib><creatorcontrib>Bennett, Desmond J</creatorcontrib><creatorcontrib>Chenelle, Christopher T</creatorcontrib><creatorcontrib>Fisher, Daniel F</creatorcontrib><creatorcontrib>Kacmarek, Robert M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Itagaki, Taiga</au><au>Bennett, Desmond J</au><au>Chenelle, Christopher T</au><au>Fisher, Daniel F</au><au>Kacmarek, Robert M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study</atitle><jtitle>Respiratory care</jtitle><addtitle>Respir Care</addtitle><date>2017-01</date><risdate>2017</risdate><volume>62</volume><issue>1</issue><spage>10</spage><epage>21</epage><pages>10-21</pages><issn>0020-1324</issn><eissn>1943-3654</eissn><abstract>Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently.
Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (V
) before and after the change in leak was assessed.
The differences in delivered V
between before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline V
was ≥10% greater than set V
during PC-CSV, and delivered V
markedly changed with leak. The Avea demonstrated persistent high V
in all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV.
The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted V
. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.</abstract><cop>United States</cop><pub>Daedalus Enterprises, Inc</pub><pmid>27879380</pmid><doi>10.4187/respcare.05012</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Birth weight, Low Computer Simulation Equipment Failure Health aspects Humans Infant, Newborn Infants (Newborn) Intensive Care Units Lung - physiology Manikins Models, Biological Respiration, Artificial - instrumentation Tidal Volume Ventilation Ventilators, Mechanical |
| title | Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study |
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