Lebret Marius, Fresnel Emeline, Prouvez Nathan, Zhu Kaixian, Kerfourn Adrien, Richard Jean-Christophe, Patout Maxime
Med2 Lab, Air Liquide Medical Systems, 92022 Antony, France.
Erphan, Paris-Saclay University, UVSQ, 78646 Versailles, France.
Healthcare (Basel). 2022 Nov 30;10(12):2416. doi: 10.3390/healthcare10122416.
The impact of leaks has mainly been assessed in bench models using continuous leak patterns which did not reflect real-life leakage. We aimed to assess the impact of the pattern and intensity of unintentional leakage (UL) using several respiratory models.
An active artificial lung (ASL 5000) was connected to three bilevel-ventilators set in pressure mode; the experiments were carried out with three lung mechanics (COPD, OHS and NMD) with and without upper airway obstruction. Triggering delay, work of breathing, pressure rise time, inspiratory pressure, tidal volume, cycling delay and the asynchrony index were measured at 0, 6, 24 and 36 L/min of UL. We generated continuous and inspiratory UL.
Compared to 0 L/min of UL, triggering delays were significantly higher with 36 L/min of UL (+27 ms) and pressure rise times were longer (+71 ms). Cycling delays increased from -4 [-250-169] ms to 150 [-173-207] ms at, respectively 0 L/min and 36 L/min of UL and work of breathing increased from 0.15 [0.12-0.29] J/L to 0.19 [0.16-0.36] J/L. Inspiratory leakage pattern significantly increased triggering delays (+35 ms) and cycling delays (+263 ms) but decreased delivered pressure (-0.94 cmHO) compared to continuous leakage pattern. Simulated upper airway obstruction significantly increased triggering delay (+199 ms), cycling delays (+371 ms), and decreased tidal volume (-407 mL) and pressure rise times (-56 ms).
The pattern of leakage impacted more the device performances than the magnitude of the leakage per se. Flow limitation negatively reduced all ventilator performances.
泄漏的影响主要是在使用连续泄漏模式的实验台模型中进行评估的，而这种模式并不能反映实际的泄漏情况。我们旨在使用多种呼吸模型评估无意泄漏（UL）的模式和强度的影响。
将一个主动人工肺（ASL 5000）连接到三台设置为压力模式的双水平呼吸机上；实验在三种肺力学状态（慢性阻塞性肺疾病、肥胖低通气综合征和神经肌肉疾病）下进行，有或没有上气道阻塞。在0、6、24和36 L/min的UL情况下测量触发延迟、呼吸功、压力上升时间、吸气压力、潮气量、循环延迟和不同步指数。我们产生了连续和吸气性UL。
与0 L/min的UL相比，36 L/min的UL时触发延迟显著更高（增加27毫秒），压力上升时间更长（增加71毫秒）。循环延迟在0 L/min和36 L/min的UL时分别从-4 [-250 - 169]毫秒增加到150 [-173 - 207]毫秒，呼吸功从0.15 [0.12 - 0.29]焦耳/升增加到0.19 [0.16 - 0.36]焦耳/升。与连续泄漏模式相比，吸气泄漏模式显著增加触发延迟（增加35毫秒）和循环延迟（增加263毫秒），但降低了输送压力（降低0.94厘米水柱）。模拟上气道阻塞显著增加触发延迟（增加199毫秒）、循环延迟（增加371毫秒），并降低潮气量（降低407毫升）和压力上升时间（降低56毫秒）。
泄漏模式对设备性能的影响大于泄漏本身的程度。流量限制会对所有呼吸机性能产生负面影响。
