University of Michigan Medical School, Ann Arbor, Michigan.
Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan.
Respir Care. 2020 Sep;65(9):1339-1345. doi: 10.4187/respcare.07346. Epub 2020 Mar 24.
Infant respiratory distress remains a significant problem worldwide, leading to more than one million neonatal deaths each year. The cost, maintenance, energy, and personnel required to implement ventilators have proven to be a barrier in many resource-limited settings. To address these barriers, a nonelectric bubble noninvasive positive pressure ventilation (NIV) device was developed. This study aims to benchmark the performance of this bubble NIV device against commercially available ventilators.
The delivered pressure waveforms and tidal volumes of the bubble NIV device were compared with those of 2 conventional ventilators (ie, Dräger Evita Infinity V500 and Hamilton G5) at the following pressure settings: 8/5, 12/5, and 15/5 cm HO. To simulate the lung mechanics of an infant in respiratory distress, tests were conducted on the IngMar ASL 5000 Test Lung simulator. Resistance was set at 100 cm HO/L/s, and compliance was tested at 0.5, 1.0, and 2.0 mL/cm HO to simulate 3 different patients.
The delivered pressure waveforms and compliance curves of the bubble NIV device are similar to those of the Hamilton and Dräger ventilators. The mean ± SD differences between delivered versus set pressure gradient (ie, the difference between the high delivered pressure and the low delivered pressure) for each treatment modality across the various values of compliance were -2 ± 8% for the bubble NIV device, 3 ± 4% for the Dräger ventilator, and 7 ± 10% for the Hamilton ventilator.
The similarity of pressure waveforms and delivered tidal volumes in this simulated clinical scenario suggest that the bubble NIV device may provide comparable efficacy compared with traditional ventilator treatment for a range of patients. This may provide clinicians in resource-limited settings with an additional, simple, nonelectric treatment modality for the management of infant respiratory distress.
婴儿呼吸窘迫仍然是一个全球性的重大问题，每年导致超过 100 万新生儿死亡。在许多资源有限的环境中，实施呼吸机所需的成本、维护、能源和人员都被证明是一个障碍。为了解决这些障碍，开发了一种非电动气泡无创正压通气（NIV）设备。本研究旨在将这种气泡 NIV 设备的性能与商业上可用的呼吸机进行基准比较。
在以下压力设置下，将气泡 NIV 设备的输送压力波形和潮气量与 2 种常规呼吸机（即，Drager Evita Infinity V500 和 Hamilton G5）的输送压力波形和潮气量进行比较：8/5、12/5 和 15/5 cmH2O。为了模拟呼吸窘迫婴儿的肺力学，在 IngMar ASL 5000 测试肺模拟器上进行了测试。阻力设置为 100 cmH2O/L/s，顺应性测试值为 0.5、1.0 和 2.0 mL/cmH2O，以模拟 3 种不同的患者。
气泡 NIV 设备的输送压力波形和顺应性曲线与 Hamilton 和 Dräger 呼吸机相似。在各种顺应性值下，每种治疗方式的输送与设定压力梯度（即高输送压力与低输送压力之间的差值）之间的平均差异分别为±8%，气泡 NIV 设备为±2%，Drager 呼吸机为±3%，Hamilton 呼吸机为±7%。
在这种模拟临床情况下，压力波形和输送潮气量的相似性表明，气泡 NIV 设备可能与传统呼吸机治疗在一定范围内的患者相比提供相当的疗效。这可能为资源有限环境中的临床医生提供一种额外的、简单的、非电动的治疗方法，用于管理婴儿呼吸窘迫。
