Castro Sara Martínez, Belda Nacher Francisco Javier, Navarro Carlos Delgado, Puig Bernabeu Jaume
Hospital Clínico Universitario, Valencia, Spain.
University of Valencia, Valencia, Spain.
Respir Care. 2021 Oct;66(10):1531-1541. doi: 10.4187/respcare.08650.
The growing number of patients on home mechanical ventilation has driven considerable progress in the performance and functionality of ventilators, with features comparable with those used in the ICU. However, a publication gap exists in the evaluation and comparison of their performance and each ventilator choice depends on machine characteristics defined by manufacturers.
We bench tested 8 home-care ventilators that are currently available: Monnal T50, EOVE EO-150, Puritan Bennet 560, Weinmann, PrismaVent 50, Trilogy Evo, Astral 150, and Vivo 60 by using an active lung model. These devices were tested under 18 experimental conditions that combined 3 variables: respiratory mechanics, ventilatory mode, and inspiratory muscle effort. The volume delivered, trigger response, pressurization capacity, and synchronization were analyzed.
Significant differences were observed in the performance among the devices. Decreased inspiratory muscle effort caused changes in the delivered volume, which worsened the response-to-trigger time, pressurization capacity, and synchronization. Increased pressure support favored the development of asynchronies. All the ventilators developed asynchronies under at least 1 set of conditions, but the EOVE and Trilogy Evo ventilators showed the fewest asynchronies during the experimental conditions studied.
Great variability in terms of technical performance was observed among the 8 home-care ventilators analyzed. Asynchronies became a major issue when home mechanical ventilation was used under higher pressure-support values and lower muscle efforts. Our results may prove to be useful in helping choose the best suited machine based on a patient's clinical therapy needs.
接受家庭机械通气的患者数量不断增加，推动了呼吸机在性能和功能方面取得显著进展，其功能可与重症监护病房（ICU）使用的呼吸机相媲美。然而，在呼吸机性能评估和比较方面存在文献空白，且每种呼吸机的选择取决于制造商定义的机器特性。
我们使用主动肺模型对目前市面上的8款家用呼吸机进行了台架测试：Monnal T50、EOVE EO - 150、Puritan Bennet 560、Weinmann、PrismaVent 50、Trilogy Evo、Astral 150和Vivo 60。这些设备在18种实验条件下进行测试，这些条件组合了3个变量：呼吸力学、通气模式和吸气肌用力。分析了输送的容积、触发反应、增压能力和同步性。
各设备之间在性能上存在显著差异。吸气肌用力降低会导致输送容积发生变化，进而使触发反应时间、增压能力和同步性变差。压力支持增加有利于不同步的发生。所有呼吸机在至少一组条件下都会出现不同步，但在研究的实验条件下，EOVE和Trilogy Evo呼吸机出现的不同步最少。
在所分析的8款家用呼吸机中，观察到技术性能存在很大差异。当在较高压力支持值和较低肌肉用力情况下使用家庭机械通气时，不同步成为一个主要问题。我们的结果可能有助于根据患者的临床治疗需求选择最适合的机器。
