Anesthesia and Critical Care Department, Hospital Clínico Universitario de Valencia (HCUV), Valencia, Spain.
Universidad de Valencia (UV), Valencia, Spain.
J Clin Monit Comput. 2023 Dec;37(6):1497-1511. doi: 10.1007/s10877-023-01019-z. Epub 2023 Jul 31.
Global pandemic due to COVID-19 has increased the interest for ventilators´ use worldwide. New devices have been developed and older ones have undergone a renewed interest, but we lack robust evidence about performance of each ventilator to match appropriate device to a given patient and care environment. The aim of this bench study was to investigate the performance of six devices for noninvasive ventilation, and to compare them in terms of volume delivered, trigger response, pressurization capacity and synchronization in volume assisted controlled and pressure support ventilation. All ventilators were tested under thirty-six experimental conditions by using the lung model ASL5000® (IngMar Medical, Pittsburgh, PA). Two leak levels, two muscle inspiratory efforts and three mechanical patterns were combined for simulation. Trigger function was assessed by measurement of trigger-delay time. Pressurization capacity was evaluated as area under the pressure-time curve over the first 500 ms after inspiratory effort onset. Synchronization was evaluated by the asynchrony index and by incidence and type of asynchronies in each condition. All ventilators showed a good performance, even if pressurization capacity was worse than expected. Leak level did not affect their function. Differences were found during low muscle effort and obstructive pattern. In general, Philips Trilogy Evo/EV300 and Hamilton C3 showed the best results. NIV devices successfully compensate air leaks but still underperform with low muscle effort and obstructive lungs. Clinicians´ must have a clear understanding of the goals of NIV both for devices´ choice and set main parameters to achieve therapy success.
由于 COVID-19 引发的全球大流行，提高了全球对呼吸机使用的兴趣。新设备已经开发出来，旧设备也重新受到关注，但我们缺乏关于每种呼吸机性能的可靠证据，无法将合适的设备匹配给特定的患者和护理环境。本 bench 研究的目的是研究六种用于无创通气的设备的性能，并在体积输送、触发响应、加压能力和在容量辅助控制和压力支持通气中的同步方面对它们进行比较。所有呼吸机都在使用肺模型 ASL5000®（IngMar Medical，匹兹堡，PA）的 36 种实验条件下进行了测试。模拟了两种漏气水平、两种肌肉吸气努力和三种机械模式。通过测量触发延迟时间来评估触发功能。加压能力通过在吸气努力开始后 500 毫秒内压力-时间曲线下的面积来评估。通过异步指数以及在每种情况下的异步发生率和类型来评估同步。所有呼吸机的性能都很好，即使加压能力不如预期。漏气水平并不影响它们的功能。在低肌肉努力和阻塞模式下发现了差异。总体而言，飞利浦 Trilogy Evo/EV300 和 Hamilton C3 表现最好。NIV 设备可以成功补偿空气泄漏，但在低肌肉努力和阻塞性肺部情况下仍表现不佳。临床医生必须清楚了解 NIV 的目标，包括设备选择和设置主要参数，以实现治疗成功。
