The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Rob DiBlasi1, Tara Mahaffey2, Dave Crotwell1, Leslie Hill1, John Salyer1; 1Respiratory Care, Seattle Children's Hospital, Seattle, WA; 2Respiratory Therapy Program, Highline Community College, Seattle, WA

BACKGROUND: Infants with chronic lung disease (CLD) commonly require invasive ventilation extending beyond the ICU setting. Many of these infants have a difficult time transitioning to subacute care ventilators presumably because they have difficulty triggering breaths. These limitations can result in prolonged ICU admission and increased hospital stay. We conducted experiments to evaluate trigger response and other performance characteristics in four flow-triggered subacute care ventilators. We hypothesized there would be no differences in ventilator performance comparing the Trilogy 202 (Philips Healthcare, Andover, MA), I-Vent 101 (GE Healthcare, Madison, WI) and LTV models 1000/1200(Carefusion, Yorba Linda, CA) in a simulated spontaneously breathing infant with CLD. METHODS: Ventilators were equipped with proprietary patient circuits and a leak test was performed. They were then attached to a spontaneously breathing lung model (Ingmar ASL 5000) configured with mechanics similar to those measured in an infant with CLD (C: 4 mL/cmH2O, R:150 cmH20/L/s, Pleural Pressure: -12 cmH2O, RR: 40) via a Custom 3.5 ID Neo Bivona TTS trach . Settings included Assist-Control/Pressure Control mode, PIP:24 cmH2O, PEEP:8 cmH2O, RR: 20 breaths/min, TI: 0.4 sec, Rise Time:1, Leak Compensation: ON, and Flow Trigger Level:1. Measurements of pressure-time product (PTP; an index of trigger work), PIP, PEEP, and tidal volume were obtained from the ASL 5000 (n=20). We assessed lung model graphics post-hoc to assess frequency of triggered breaths (Trigger Breath %= Total #spontaneous inspiratory efforts/#triggered ventilator breaths). In situations where all breaths were triggered, VT accuracy between the measured and delivered VT was calculated (% Error). RESULTS: Table 1 shows data for each ventilator and circuit configuration being used. Values are reported as Mean +/- SD. TheTrilogy 202, with flow triggering using passive and active flow circuits, was the only ventilator to capture 100% of spontaneous respiratory efforts at lower PTPs than the other ventilators tested. The Trilogy 202 and LTV 1000 provided better PEEP stabilization than the I-Vent 101 and LTV 1200. CONCLUSION/DISCUSSION: Based on these data, the Trilogy 202 may extend the ability for transitioning patients from critical care ventilators to subacute care ventilators more easily. This is due in part to the use of an incorporated proximal flow sensor placed at the airway.
Sponsored Research - Ventilators were loaned for this study