Bench Model Comparison of CPAP Delivery in Four Home Care Ventilators

Abstract

Background: CPAP is widely utilized as a treatment for obstructive sleep apnea (OSA) across the pediatric and adult populations. Many machines are available for CPAP delivery in the home care setting ranging from Respiratory Assist Devices to CPAP devices. Most of these devices have not been studied for use in the infant population, creating a barrier to discharge for infants with mild bronchopulmonary dysplasia (BPD), laryngomalacia, and OSA. We aim to demonstrate equivalency of CPAP delivery across available home care devices to allow providers a broader range of options when prescribing CPAP for home use in the infant and pediatric populations. We hypothesize that each device will perform similarly, with no significant variation in CPAP delivery.

Methods: A bench study using the ASL 5000 Active Servo Lung Precision Breathing Simulator programmed as a 5 kilogram, actively breathing infant with mild BPD: RR = 30 breaths/min, resistance (inspiratory) = 70 cm H₂O/L/s, resistance (expiratory) = 90 cm H₂O/L/s, compliance = 2 mL/cm H₂O, and FRC = 0.2 L. An infant mannequin head with patent nares and mouth was connected to the ASL 5000 and CPAP delivered via the Wisp (Philips Respironics) pediatric nasal mask measured by the ASL for four available home care machines. One Respiratory Assist Device: Trilogy 100 (Philips Respironics) and three CPAP devices: REMstar (Philips Respironics), DreamStation (Philips Respironics), and VPAP III (ResMed) were evaluated. Machines were set in CPAP mode ranging from 5 to 10 cm H₂O and each simulation ran for three minutes. Mean airway pressure was averaged from the last 5 full breaths at each CPAP level collected with both closed and open mouth conditions. Pearson Bivariate Analysis and Multiple Linear Regression models were performed to show the relationship between each machine for the mouth closed and mouth open conditions with two-tailed significance level of 0.05.

Results: The correlation between machines for each set level of CPAP for the Trilogy, REMstar, Dream Station and VPAP was 0.999, 1.00, 0.999, and 0.995 respectively (P<0.001). There was a direct positive linear relationship for each machine at each CPAP level (Figure 1).

Conclusions: There was a strong correlation between set level of CPAP achieved between each ventilator indicating that there was no statistically significant difference in CPAP delivery between the Respiratory Assist Device vs. CPAP devices tested.

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