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Fresnel E, Vedrenne-Cloquet M, Lebret M, Griffon L, Fauroux B, Khirani S. Detection of Simulated Pediatric Breathing by CPAP/NIV Devices. Respir Care 2023:respcare.10785. [PMID: 37221084 PMCID: PMC10353172 DOI: 10.4187/respcare.10785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Home CPAP and noninvasive ventilation (NIV) are increasingly used in children. An appropriate choice of the CPAP/NIV device, according to the manufacturer recommendations, should guarantee accurate data collection software. However, not all devices display accurate patient data. We hypothesized that the detection of patient breathing may be expressed as a minimal tidal volume (VTmin ) rather than a minimal weight. The aim of the study was to estimate the VTmin detected by home ventilators when set on CPAP. METHODS Twelve level I-III devices were analyzed using a bench test. Pediatric profiles were simulated with increasing VT values to determine the VTmin that the ventilator may detect. The duration of CPAP use and the presence/absence of waveform tracings on the built-in software were also gathered. RESULTS VTmin varied according to the device, ranging from 16-84 mL, independent of level category. The duration of CPAP use was underestimated in all level I devices, which were either not able to display any waveform or only intermittently, until VTmin was reached. The duration of CPAP use was overestimated for the level II and III devices, with the display of different waveforms according to the device as soon as the device was switched on. CONCLUSIONS Based on the VTmin detected, some level I and II devices may be suitable for infants. A careful testing of the device should be done at CPAP initiation, with a review of data generated from ventilator software.
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Affiliation(s)
| | | | - Marius Lebret
- Kernel Biomedical, Rouen, France; and Université Paris-Saclay, UVSQ, Erphan Paris-Saclay University, Versailles, France
| | - Lucie Griffon
- Pediatric Sleep and Noninvasive Ventilation Unit, AP-HP Necker Hospital, Paris, France; and Université Paris Cité, VIFASOM, Paris, France
| | - Brigitte Fauroux
- Pediatric Sleep and Noninvasive Ventilation Unit, AP-HP Necker Hospital, Paris, France; and Université Paris Cité, VIFASOM, Paris, France
| | - Sonia Khirani
- Pediatric Sleep and Noninvasive Ventilation Unit, AP-HP Necker Hospital, Paris, France; Université Paris Cité, VIFASOM, Paris, France; and ASV Santé, Gennevilliers, France.
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Affiliation(s)
- Giuseppe Fiorentino
- 1 Department of Cardiorespiratory Disease and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Antonio M Esquinas
- 2 Intensive Care Unit and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
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Ogna A, Prigent H, Falaize L, Leroux K, Santos D, Vaugier I, Orlikowski D, Lofaso F. Accuracy of tidal volume delivered by home mechanical ventilation during mouthpiece ventilation: A bench evaluation. Chron Respir Dis 2016; 13:353-360. [PMID: 27146811 DOI: 10.1177/1479972316647177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to evaluate efficacy and reliability of currently available ventilators for mouthpiece ventilation (MPV). Five life-support home ventilators were assessed in a bench test using different settings simulating the specificities of MPV, such as intermittent circuit disconnection and presence of continuous leaks. The intermittent disconnection of the circuit caused relevant swings in the delivered tidal volume ( VT), showing a VT overshoot during the disconnection periods and a VT decrease when the interface was reconnected to the test lung. The five ventilators showed substantial differences in the number of respiratory cycles necessary to reach a stable VT in the volume-controlled setting, ranging from 1.3 ± 0.6 to 7.3 ± 1.2 cycles. These differences were less accentuated in the volume-assisted setting (MPV-dedicated mode, when available). Our data show large differences in the capacity of the different ventilators to deal with the rapidly changing respiratory load features that characterize MPV, which can be further accentuated according to the used ventilator setting. The dedicated MPV modes allow improvement in the performance of ventilators only in some defined situations. This has practical consequences for the choice of the ventilator to be used for MPV in a specific patient.
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Affiliation(s)
- Adam Ogna
- 1 AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, Garches, France
| | - Helene Prigent
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
| | - Line Falaize
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France.,3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | | | - Dante Santos
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
| | - Isabelle Vaugier
- 3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | - David Orlikowski
- 1 AP-HP, Hôpital Raymond Poincaré, Service de Réanimation médicale et unité de ventilation à domicile, Garches, France.,3 AP-HP, Hôpital Raymond Poincaré INSERM CIC 14.29, Garches, France
| | - Frederic Lofaso
- 2 AP-HP, Hôpital Raymond Poincaré, Service de Physiologie-Explorations Fonctionnelles, Garches, France
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Khirani S, Ramirez A, Delord V, Leroux K, Lofaso F, Hautot S, Toussaint M, Orlikowski D, Louis B, Fauroux B. Evaluation of ventilators for mouthpiece ventilation in neuromuscular disease. Respir Care 2014; 59:1329-37. [PMID: 24847097 DOI: 10.4187/respcare.03031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Daytime mouthpiece ventilation is a useful adjunct to nocturnal noninvasive ventilation (NIV) in patients with neuromuscular disease. The aims of the study were to analyze the practice of mouthpiece ventilation and to evaluate the performance of ventilators for mouthpiece ventilation. METHODS Practice of mouthpiece ventilation was assessed by a questionnaire, and the performance of 6 home ventilators with mouthpiece ventilation was assessed in a bench test using 24 different conditions per ventilator: 3 mouthpieces, a child and an adult patient profile, and 4 ventilatory modes. RESULTS Questionnaires were obtained from 30 subjects (mean age 33 ± 11 y) using NIV for 12 ± 7 y. Fifteen subjects used NIV for > 20 h/day, and 11 were totally ventilator-dependent. The subject-reported benefits of mouthpiece ventilation were a reduction in dyspnea (73%) and fatigue (93%) and an improvement in speech (43%) and eating (27%). The bench study showed that none of the ventilators, even those with mouthpiece ventilation software, were able to deliver mouthpiece ventilation without alarms and/or autotriggering in each condition. Alarms and/or ineffective triggering or autotriggering were observed in 135 of the 198 conditions. The occurrence of alarms was more common with a large mouthpiece without a filter compared to a small mouthpiece with a filter (P < .001), but it was not related to the patient profile, the ventilatory mode, or the type of ventilator. CONCLUSIONS Subjects are satisfied with mouthpiece ventilation. Alarms are common with home ventilators, although less common in those with mouthpiece ventilation software. Improvements in home ventilators are needed to facilitate the expansion of mouthpiece ventilation.
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Affiliation(s)
- Sonia Khirani
- Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. S2A Santé, Ivry sur Seine, France
| | - Adriana Ramirez
- Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France
| | | | - Karl Leroux
- Association d'Entraide des Polios et Handicapés Assistance, Suresnes, France
| | - Frédéric Lofaso
- Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, and the Centre d'Innovations Technologiques Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles, Saint-Quentin-en-Yvelines, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France
| | - Solène Hautot
- IBIOM, Ingénierie pour le Biomédical, Faculté des Sciences et Techniques, Université de Rouen, Saint-Étienne du Rouvray, France
| | - Michel Toussaint
- Neuromuscular Excellence Center, VUB-Inkendaal, and the Center for Home Mechanical Ventilation, Z.H. Inkendaal Rehabilitation Hospital, Brussels, Belgium
| | - David Orlikowski
- Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France, and the Université de Versailles, Saint-Quentin-en-Yvelines, France
| | - Bruno Louis
- Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France
| | - Brigitte Fauroux
- Pediatric Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paris, France. Institut National de la Santé et de la Recherche Médicale U955, Université Paris Est, Faculté de Médecine, Centre National de la Recherche Scientifique ERL 7240, Créteil, France. Université Pierre et Marie Curie-Paris 6, Paris, France.
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Falaize L, Leroux K, Prigent H, Louis B, Khirani S, Orlikowski D, Fauroux B, Lofaso F. Battery life of portable home ventilators: effects of ventilator settings. Respir Care 2013; 59:1048-52. [PMID: 24149669 DOI: 10.4187/respcare.02711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The battery life (BL) of portable home ventilator batteries is reported by manufacturers. The aim of this study was to evaluate the effects of ventilator mode, breathing frequency, PEEP, and leaks on the BL of 5 commercially available portable ventilators. METHODS The effects of the ventilator mode (volume controlled-continuous mandatory ventilation [VC-CMV] vs pressure support ventilation [PSV]), PEEP 5 cm H2O, breathing frequency (10, 15, and 20 breaths/min), and leaks during both volume-targeted ventilation and PSV on the BL of 5 ventilators (Elisée 150, Monnal T50, PB560, Vivo 50, and Trilogy 100) were evaluated. Each ventilator was ventilated with a test lung at a tidal volume of 700 ml and an inspiratory time of 1.2 s in the absence of leaks. RESULTS Switching from PSV to VC-CMV or the addition of PEEP did not significantly change ventilator BL. The increase in breathing frequency from 10 to 20 breaths/min decreased the BL by 18 ± 11% (P = .005). Leaks were associated with an increase in BL during the VC-CMV mode (18 ± 20%, P = .04) but a decrease in BL during the PSV mode (-13 ± 15%, P = .04). CONCLUSIONS The BL of home ventilators depends on the ventilator settings. BL is not affected by the ventilator mode (VC-CMV or PSV) or the addition of PEEP. BL decreases with an increase in breathing frequency and during leaks with a PSV mode, whereas leaks increase the duration of ventilator BL during VC-CMV.
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Affiliation(s)
- Line Falaize
- Service de Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, et Centre d'Innovations Technologiques, Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, France
| | | | - Hélène Prigent
- Service de Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, et Centre d'Innovations Technologiques, Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, France
| | - Bruno Louis
- Institut National de la Santé et de la Recherche Médicale, U995, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; and Centre National de la Recherche Scientifique, ERL 7240, Créteil, France
| | - Sonia Khirani
- Pediatric Pulmonary Department, Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France, and Pierre et Marie Curie University, Paris, France.S2A Santé, Ivry-sur-Seine, France
| | - David Orlikowski
- Service de Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, et Centre d'Innovations Technologiques, Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, France
| | - Brigitte Fauroux
- Pediatric Pulmonary Department, Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France, and Pierre et Marie Curie University, Paris, France
| | - Frédéric Lofaso
- Service de Physiologie-Explorations Fonctionnelles, Services de Réanimation Médicale, et Centre d'Innovations Technologiques, Unité Mixte de Recherche 805, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, France.
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