Université Paris Est-Créteil, Faculté de Santé, Groupe de Recherche Clinique CARMAS, 94010, Créteil, France.
Med2Lab Laboratory, ALMS, Antony, France.
Crit Care. 2023 Jul 4;27(1):262. doi: 10.1186/s13054-023-04542-2.
Several noninvasive ventilatory supports rely in their design on high oxygen consumption which may precipitate oxygen shortage, as experienced during the COVID-19 pandemic. In this bench-to-bedside study, we assessed the performance of a new continuous positive airway pressure (CPAP) device integrating a large reservoir ("Bag-CPAP") designed to minimize oxygen consumption, and compared it with other CPAP devices.
First, a bench study compared the performances of Bag-CPAP and four CPAP devices with an intensive care unit ventilator. Two FiO targets (40-60% and 80-100%) at a predefined positive end expiratory pressure (PEEP) level between 5 and 10 cm HO were tested and fraction of inspired oxygen (FiO) and oxygen consumption were measured. Device-imposed work of breathing (WOB) was also evaluated. Second, an observational clinical study evaluated the new CPAP in 20 adult patients with acute respiratory failure in two hospitals in France. Actual FiO, PEEP, peripheral oxygen saturation, respiratory rate, and dyspnea score were assessed.
All six systems tested in the bench study reached the minimal FiO target of 40% and four reached at least 80% FiO while maintaining PEEP in the predefined range. Device-delivered FiO/consumed oxygen ratio was the highest with the new reservoir-based CPAP irrespective of FiO target. WOB induced by the device was higher with Bag-CPAP. In the clinical study, Bag-CPAP was well tolerated and could reach high (> 90%) and moderate (> 50%) FiO with an oxygen flow rate of 15 [15-16] and 8 [7-9] L/min, respectively. Dyspnea score improved significantly after introduction of Bag-CPAP, and SpO increased.
In vitro, Bag-CPAP exhibited the highest oxygen saving properties albeit had increased WOB. It was well accepted clinically and reduced dyspnea. Bag-CPAP may be useful to treat patients with acute respiratory failure in the field, especially when facing constraints in oxygen delivery.
在设计上，有几种无创通气支持依赖于高耗氧量，这可能会导致氧气短缺，正如在 COVID-19 大流行期间所经历的那样。在这项从实验室到临床的研究中，我们评估了一种新的持续气道正压通气（CPAP）设备的性能，该设备集成了一个旨在最大限度减少耗氧量的大型储气囊（“Bag-CPAP”），并将其与其他 CPAP 设备进行了比较。
首先，在实验室研究中，我们比较了 Bag-CPAP 与四种 CPAP 设备和一种重症监护病房呼吸机的性能。在 5 至 10cmH2O 之间预设的呼气末正压（PEEP）水平下，测试了两种 FiO2 目标（40-60% 和 80-100%），并测量了吸入氧分数（FiO2）和耗氧量。还评估了设备引起的呼吸功（WOB）。其次，在法国的两家医院中，一项针对 20 例急性呼吸衰竭成人患者的观察性临床研究评估了新的 CPAP。评估了实际的 FiO2、PEEP、外周血氧饱和度、呼吸频率和呼吸困难评分。
在实验室研究中，所有六种系统都达到了最小 FiO2 目标 40%，四种系统至少达到了 FiO2 目标 80%，同时维持了预设范围内的 PEEP。无论 FiO2 目标如何，新的基于储气囊的 CPAP 系统的设备输送 FiO2/消耗氧气的比值最高。Bag-CPAP 引起的 WOB 较高。在临床研究中，Bag-CPAP 耐受性良好，可以以 15[15-16]和 8[7-9]L/min 的氧气流量达到高（>90%）和中度（>50%）FiO2。引入 Bag-CPAP 后，呼吸困难评分显著改善，SpO2 增加。
在体外，Bag-CPAP 表现出最高的氧气节约特性，尽管 WOB 增加。它在临床上得到了很好的接受，并减轻了呼吸困难。Bag-CPAP 可用于治疗急性呼吸衰竭患者，特别是在面临供氧限制时。
