The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

SIMULATED NEONATAL PATIENT-VENTILATOR INTERACTION USING SIPAP AND BILEVEL NCPAP

Shannon E. Cook, Robert L. Chatburn; Respiratory Institute, The Cleveland Clinic, Cleveland, OH

INTRODUCTION: Although SiPAP (Viasys Healthcare) has been available for several years, it has remained relatively unexplored. Studies have evaluated BiPAP, SiPAP’s close relative, but not SiPAP itself. We sought to test SiPAP against non invasive positive pressure ventilation from the Avea ventilator (Viasys), specifically looking at effect on tidal volume (V), patient work (W), drop to minimum pressure during inspiration (DPmin) and mean airway pressure (MAP). METHODS: The Avea and SiPAP were tested on an ASL 5000 lung simulator (Ingmar Medical, Inc). Lung simulator settings were: resistance = 125 cm H2O/L/s, compliance = 0.5 mL/cm H2O, rate = 65 breaths/min, patient effort (Pmus) = sinusoidal, 6.5- 19.5 cm H2O to generate tidal volumes of 3-9 mL, rise = 33%, hold = 0%, release = 33%. Nares were simulated by holes drilled into plastic tube. Nasal prongs were fitted according to the sizing template of the Infant Flow System (Viasys). The flow settings for the SiPAP were adjusted to approximate pressure settings on the Avea: “pressure high” flow = 3.75 L/min; “pressure low” flow = 6.5 L/min, which resulted in peak inspiratory pressure (PIP) = 9.8-10.8 cm H2O (fluctuated automatically, highest possible without alarming); positive end expiratory pressure (PEEP) = 4.8-5.5 cm H2O. For the Avea, in Bilevel NCPAP mode, PIP = 10 cm H2O, PEEP = 5 cm H2O. Rate on both machines was set to 20 breaths/min. Medium nasal prongs and a neonatal circuit (Infant Flow System) were used for the SiPAP setup and a Fisher and Paykel circuit and prongs (4030) were used for the ventilator. Both used a Fisher and Paykel neonatal humidifier. Averages of 10 breaths were used for analysis (ANOVA on V and W, t-tests on DPmin and MAP, p<0.05 significant). RESULTS: Both the SiPAP and Avea had large ranges of delivered tidal volume. Data are included in the figure. There was no significant difference at any of the Pmus levels for V, MAP or W. Only the DPmin at V = 9 mL had significance (P=0.01). CONCLUSIONS: SiPAP appears to offer the same quality support as that of the Avea ventilator with regard to V, W, DPmin and MAP. The variation in tidal volume is due to the non synchronized mandatory breaths. While some V were twice as large as unassisted breaths, others were half as large and thus loaded. On average, the SiPAP and the Avea offered the same tidal volume as unassisted. Sponsored Research - None

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