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Ventilator modes and settings during non-invasive ventilation: effects on respiratory events and implications for their identification
  1. Claudio Rabec1,
  2. Daniel Rodenstein2,
  3. Patrick Leger3,
  4. Sylvie Rouault4,
  5. Christophe Perrin5,
  6. Jésus Gonzalez-Bermejo6 on behalf of the SomnoNIV group
  1. 1Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, France
  2. 2Service de Pneumologie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
  3. 3Service de Pneumologie, Centre Hospitalier Lyon Sud, Lyon France
  4. 4ADEP Assistance, Paris, France
  5. 5Service de Pneumologie, Centre Hospitalier de Cannes, Cannes, France
  6. 6Service de Pneumologie et Réanimation Respiratoire, Hôpital de la Pitié-Salpétriere and UPMC ER10, Paris, France
  1. Correspondence to Claudio Rabec, Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, 2 Bd Maréchal de Lattre de Tassigny, 21079 Dijon, France; claudio.rabec{at}chu-dijon.fr

Abstract

Compared with invasive ventilation, non-invasive ventilation (NIV) has two unique characteristics: the non-hermetic nature of the system and the fact that the ventilator-lung assembly cannot be considered as a single-compartment model because of the presence of variable resistance represented by the upper airway. When NIV is initiated, the ventilator settings are determined empirically based on a clinical evaluation and diurnal blood gas variations. However, NIV is predominantly applied during sleep. Consequently, to assess overnight patient–machine ‘agreement’ and efficacy of ventilation, more specific and sophisticated monitoring is needed. The effectiveness of NIV might therefore be more correctly assessed by sleep studies than by daytime assessment. The most available and simple monitoring can be done from flow and pressure curves from the mask or the ventilator circuit. Examination of these tracings can give useful information to evaluate if the settings chosen by the operator were the right ones for that patient. However, as NIV allows a large range of ventilatory parameters and settings, it is mandatory to have information about this to better understand patient–ventilator interaction. Ventilatory modality, mode of triggering, pressurisation slope, use or not of positive end expiratory pressure and type of exhalation as well as ventilator performances may all have physiological consequences. Leaks and upper airway resistance variations may, in turn, modify these patterns. This article discusses the equipment available for NIV, analyses the effect of different ventilator modes and settings and of exhalation and connecting circuits on ventilatory traces and gives the background necessary to understand their impact on nocturnal monitoring of NIV.

  • Noninvasive ventilation
  • ventilatory modalities
  • bi-level positive airway pressure
  • respiratory failure
  • monitoring
  • respiratory measurement
  • sleep apnoea
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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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