The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

COMPARISON OF A CRITICAL CARE VENTILATOR FOR USE AS A NPPV VENTILATOR: A lung simulator and breathing test comparison of the Versamed iVent201 and Respironics Vision

Jodette A. Brewer, RRT, RCP, Scripps Mercy Hospital, San Diego, CA.

Background:    Recent developments in Critical Care Ventilators have made available their use for NPPV (non invasive positive pressure ventilation). The Respironics Vision is known throughout the clinical arena as the gold standard of NPPV.  If the traditional invasive ventilator devices can provide a clinically equivalent means of delivering NPPV, then clinicians and patients could possibly benefit. Efficiency, training and ability to quickly switch between NPPV and Invasive Ventilation may prove advantageous.  This study tested a Critical Care Transport Ventilator (Versamed iVent201, Pearl River, NY) and a NPPV Ventilator (Respironics Vision, Carlsbad, CA).  The study was designed to determine whether there were any clinically significant differences and to analyze the features of both as they apply to clinical use.

Method:
  The ventilators were tested using a lung simulation model and by spontaneous breathing.  The lung simulator was made up of a Michigan Dual adult TTL (Michigan Instruments, Inc., Grand Rapids, MI) and a PF 300 Flow/Pressure analyzer (IMT Medical, Inc., Oceanside, CA.). A ventilator was used to drive consistent triggering/demand for breath initiation for both ventilators. Flow/Pressure analysis was measured between patient interface and the Michigan TTL. Each ventilator was set-up using manufacturers recommended breathing circuits with a full face mask. Each ventilator was tested using the most sensitive trigger settings (-0.5 cmH20 / 1 lpm for the iVent201, non-adjustable for the Vision), rise time set to 0.1 seconds and expiratory sensitivity set to 40% for the iVent201 and non-adjustable for the Vision.

Results:
 Both devices were set at 3 different IPAP (inspiratory positive airway pressure) and EPAP (expiratory positive airway pressure) settings. Definitions of data collected for comparison of the iVent201 and the Vision are as follows: Response Times - amount of time required for pressure to return to baseline; Pmax - maximum pressure drop below baseline; Vmax - maximum measured inspiratory flow; Ti - total inspiratory time; Trise - time measured from baseline to target pressure:

                                Lung simulator Response Times (R.Times) and Pmax 

Settings (IPAP/EPAP) iVent R. Times/Pmax Vision R. Times/Pmax
10/5 114 ms/-2.6 cmH2O 110 ms/-1.8 cmH2O
15/8 100 ms/-3.2 cmH2O 104 ms/-2.5 cmH2O
25/10 102 ms/-3.6 cmH2O   94 ms/-2.5 cmH2O

 Spontaneous breathing test results for Vmax, Ti, Trise

Settings (IPAP/EPAP) iVent Vmax, Ti, Trise Vision Vmax, Ti, Trise
10/5 60 lpm, 1.71, .40 49 lpm, 1.91, .34
15/8 72 lpm, 1.32, .38 56 lpm, 1.71, .29
25/10 87 lpm, 1.33, .87     93 lpm, .67, .36

Conclusion: This study illustrated that the iVent201 can deliver safe and effective NPPV and that with it's added features, i.e. battery and compressor transport capability, size and weight, MRI compatibility, invasive ventilation with advance modes of ventilation, and enhanced breath delivery adjustments (expiratory sensitivity 10-90%, Rise time .1-1.5sec and Auto rise), it could positively impact patient care, staff efficiency and overall institutional costs. Further study is needed to assess NPPV and the additional features of the Versamed iVent201 as well as other critical care ventilators, and overall impact on improved patient care and institutional costs.


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