Chest
Original ResearchCritical CarePatient-Ventilator Asynchrony During Noninvasive Ventilation: A Bench and Clinical Study
Section snippets
Materials and Methods
This study involved a bench part and a clinical part. An extensive description of both the bench and clinical protocols is provided in e-Appendix 1.
Triggering Delay
The ICU and transport ventilators with their NIV algorithm turned off in the absence of leaks exhibited a total triggering delay (TD) of 117 milliseconds (99-131 milliseconds) and 143 milliseconds (114-174 milliseconds), respectively (P = .37) (Fig 2). The addition of inspiratory leaks did not significantly modify these values except for the Engstrom, G5, and T1, which had an increased TD, and the Medumat, which showed a reduced TD. Turning on the NIV algorithm while maintaining inspiratory
Discussion
To our knowledge, this study is the first to compare patient-ventilator synchronization during NIV between ICU, transport, and dedicated NIV ventilators, with both a bench and a clinical evaluation. The observations made with these two approaches were consistent, offering a strong validation of the bench model, a logical explanation for the clinical data, and lending strength to the main results of this study, which are:
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In NIV conditions, most dedicated NIV ventilators allowed better
Conclusion
In conclusion, our study shows that dedicated NIV ventilators allow a better patient-ventilator synchrony in the presence of leaks than ICU and transport ventilators, even if their NIV algorithm is engaged, especially for what concerns auto-triggering. When using an ICU or transport ventilator to perform NIV, the NIV algorithm usually improves, at least slightly and with variations among ventilators, triggering and/or cycling synchronization.
Acknowledgments
Author contributions: Dr Carteaux is the guarantor of the paper.
Dr Carteaux: contributed to the study design, patient enrollment, data collection, data analysis, data interpretation, and manuscript preparation, and read and approved the final manuscript.
Dr Lyazidi: contributed to the study design, patient enrollment, data collection, data analysis, data interpretation, and manuscript preparation, and read and approved the final manuscript.
Dr Cordoba-Izquierdo: contributed to the study design,
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For editorial comment see page 274
Funding/Support: This study was supported in part by a research grant from Philips Respironics (€10,000). This study was performed while Dr Carteaux was funded by an institutional grant, the Année Recherche, from the Ministère de l'éducation nationale, de l'enseignement supérieur et de la recherche (French Ministry for Education and Research).
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