Bench-test comparison of 26 emergency and transport ventilatorsReport as inadecuate




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Critical Care

, 18:506

First Online: 15 October 2014Received: 12 May 2014Accepted: 22 August 2014

Abstract

IntroductionNumerous emergency and transport ventilators are commercialized and new generations arise constantly. The aim of this study was to evaluate a large panel of ventilators to allow clinicians to choose a device, taking into account their specificities of use.

MethodsThis experimental bench-test took into account general characteristics and technical performances. Performances were assessed under different levels of FIO2 100%, 50% or Air-Mix, respiratory mechanics compliance 30,70,120 mL-cmH2O; resistance 5,10,20 cmH2O-mL-s, and levels of leaks 3.5 to 12.5 L-min, using a test lung.

ResultsIn total 26 emergency and transport ventilators were analyzed and classified into four categories ICU-like, n = 5; Sophisticated, n = 10; Simple, n = 9; Mass-casualty and military, n = 2. Oxygen consumption 7.1 to 15.8 L-min at FIO2 100% and the Air-Mix mode FIO2 45 to 86% differed from one device to the other. Triggering performance was heterogeneous, but several sophisticated ventilators depicted triggering capabilities as efficient as ICU-like ventilators. Pressurization was not adequate for all devices. At baseline, all the ventilators were able to synchronize, but with variations among respiratory conditions. Leak compensation in most ICU-like and 4-10 sophisticated devices was able to correct at least partially for system leaks, but with variations among ventilators.

ConclusionMajor differences were observed between devices and categories, either in terms of general characteristics or technical reliability, across the spectrum of operation. Huge variability of tidal volume delivery with some devices in response to modifications in respiratory mechanics and FIO2 should make clinicians question their use in the clinical setting.

AbbreviationsAIthe global asynchrony index between the simulated patient and the ventilator

Air-Mixdesign of a specific air-mixing condition using the Venturi effect resulting in variable oxygen inspiratory fraction

ARDSacute respiratory distress syndrome

COPDchronic obstructive pulmonary disease

CPAPcontinuous positive airway pressure

dBdecibel

DIoverall inspiratory delay, composed of the two trigger components trigger delay + pressurization delay

DPpressurization delay, which is the time at which the airway pressure signal rose

DTtriggering delay between onset of the airway pressure decay and flow delivery

EDemergency department

ETVemergency and transport ventilators

FIO2oxygen inspiratory fraction, which is a parameter for the neuro-muscular activation of the respiratory system, an important determinant for the work of breathing

NIVnoninvasive ventilation

P0.1the negative airway pressure generated during the first 100 msec of an occluded inspiration

PEEPpositive end-expiratory pressure

Pmussimulated patient-s respiratory muscle effort intensity

PSpressure support

PSVpressure support ventilation

PTPthe airway pressure-time product per cycle during the trigger phase

RRrespiratory rate

VTtidal volume

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0506-0 contains supplementary material, which is available to authorized users.

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Author: Erwan L-Her - Annie Roy - Nicolas Marjanovic

Source: https://link.springer.com/







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