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Research ArticleOriginal Research

Effect of Face Mask Design and Flow-by on Rebreathing During Noninvasive Ventilation

Davide Signori, Giacomo Bellani, Serena Calcinati, Alice Grassi, Nicolò Patroniti and Giuseppe Foti
Respiratory Care March 2019, respcare.06269; DOI: https://doi.org/10.4187/respcare.06269
Davide Signori
School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
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Giacomo Bellani
School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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  • For correspondence: [email protected]
Serena Calcinati
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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Alice Grassi
School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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Nicolò Patroniti
Department of Surgical and Integrated Diagnostical Science, University of Genoa, San Martino Hospital, Genoa, Italy.
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Giuseppe Foti
School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
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Abstract

BACKGROUND: Noninvasive ventilation (NIV) is used to treat respiratory failure because it reduces the risks of endotracheal intubation and postextubation respiratory failure. A wide range of different interfaces is available, but concerns exist about rebreathing. This study evaluated a total face mask with a 2-limb ventilation circuit and separate access for inflow and outflow gas, which was developed to reduce rebreathing.

METHODS: In a bench test, a standard total face mask (with a single connector to the ventilation circuit) and the modified total face mask were applied to a mannequin connected to an active breathing simulator. A known CO2flow (V̇CO2) was delivered to the mannequin's trachea. We tested the following settings: CPAP with the mechanical PEEP valve set at 8 cm H2O (with 60 and 90 L/min continuous flow) and pressure support of 6 and 12 cm H2O (with 2 and 15 L/min flow-by). The settings were tested at simulated breathing frequencies of 15 and 30 breaths/min and with V̇CO2 of 200 and 300 mL/min. The active simulator generated a tidal volume of 500 mL. Airway pressure, air flow, CO2 concentration, and CO2 flow as the product of air flow and CO2 were recorded.

RESULTS: The mean volume of CO2 rebreathed and the minimum CO2 inspiratory concentration were significantly lower with the modified mask than with the standard mask. The 15 L/min flow-by significantly decreased rebreathing with the DiMax0 mask, whereas it had no effect with the traditional mask.

CONCLUSIONS: A face mask with a two-limb ventilation circuit and separate access for inflow and outflow gas reduces rebreathing during NIV. The addition of flow-by enhances this effect. Further studies are required to verify the clinical relevance.

  • noninvasive ventilation
  • rebreathing
  • face mask
  • flow-by
  • bias flow
  • carbon dioxide clearance

Footnotes

  • Correspondence: Giacomo Bellani MD PhD, University of Milan-Bicocca, School of Medicine and Surgery, Via Cadore 48, Monza, Italy. E-mail: giacomo.bellani1{at}unimib.it.
  • The other authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises
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Respiratory Care: 67 (6)
Respiratory Care
Vol. 67, Issue 6
1 Jun 2022
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Effect of Face Mask Design and Flow-by on Rebreathing During Noninvasive Ventilation
Davide Signori, Giacomo Bellani, Serena Calcinati, Alice Grassi, Nicolò Patroniti, Giuseppe Foti
Respiratory Care Mar 2019, respcare.06269; DOI: 10.4187/respcare.06269

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Effect of Face Mask Design and Flow-by on Rebreathing During Noninvasive Ventilation
Davide Signori, Giacomo Bellani, Serena Calcinati, Alice Grassi, Nicolò Patroniti, Giuseppe Foti
Respiratory Care Mar 2019, respcare.06269; DOI: 10.4187/respcare.06269
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Keywords

  • noninvasive ventilation
  • rebreathing
  • face mask
  • flow-by
  • bias flow
  • carbon dioxide clearance

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