2010 OPEN FORUM Abstracts
TIME TO RECOVERY OF BASELINE BREATH DELIVERY DURING A LUNG MODEL-VENTILATOR INTERACTION OF NON-INVASIVE VENTILATION IN THE PRESENCE OF A LEAK: COMPARING THE RESPIRONICS BIPAP® VISION, RESPIRONICS V60®, AND THE HAMILTON C2®
Robert L. Joyner, Sidney R. Schneider, Donald DAquila, Maribeth Cohey; Health Sciences, Salisbury University, Salisbury, MD
Background: Ideally, mechanical ventilators providing NPPV would automatically compensate for circuit and interface leaks to ensure patient-ventilator synchrony. Manufacturers of ventilators offering NPPV attempt to improve patient-ventilator interaction by incorporating features that detect and compensate for leaks while maintaining proper triggering and cycling. Methods: A lung model-ventilator performance comparison was constructed to compare the Respironics BiPAP Vision, the Respironics V60 and the Hamilton C2 during conditions of sequenced system leak. Each ventilator evaluated in this study was exposed to a protocol that incorporated increasing and decreasing system leaks, during which time the time elapsed during recovery to a stable breath delivery pattern was recorded. For each leak condition, Repeated Measured Analysis of Variance (SPSS 17 for Windows) was used to compare within and between ventilator differences of elapsed time to recovery of a stable breath delivery pattern. Results: At levels of higher leak (i.e., 25 L/min and 50 L/min) the C2 consistently had longer recovery times than either the Vision or the V60 (p < 0.05). Conclusion: During most conditions of leak we found that the Vision and the V60 recovered to a stable breath delivery pattern faster than the C2. Worthy of note, the breathing frequency of an air hungry patient may be higher than the chosen breath rate in our spontaneous breathing lung model, and therefore it would be interesting to complete a similar evaluation in a model created to mimic a more tachypneic patient. Its conceivable that with a higher spontaneous rate, ventilators with longer recovery times may not have enough time to recognize spontaneous efforts. This would result in continuous dyssynchrony and a failed NPPV trial. This study is limited by its bench design and should be repeated in a clinical setting. Sponsored Research - Grant support from Philips/Respironics.