RT Journal Article
SR Electronic
T1 Delivering Low Tidal Volume With Anesthesia and ICU Ventilators in a Neonatal Lung Model
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.10354
DO 10.4187/respcare.10354
A1 Kyle J Medeiros
A1 Caio A Morais
A1 Dario Winterton
A1 David M Rub
A1 Roberta De Santis Santiago
A1 Nitika Shekhar
A1 Daniel Chipman
A1 Thomas T Monaghan
A1 Edward A Bittner
A1 Ryan Carroll
A1 Lorenzo Berra
YR 2023
UL http://rc.rcjournal.com/content/early/2023/02/07/respcare.10354.abstract
AB BACKGROUND: Mechanical ventilation of the neonate requires ventilators than can deliver precise and accurate tidal volume (VT) and PEEP to avoid lung injury. Due to small neonatal VT and the disproportionate effect of endotracheal tube leak in these patients, accomplishing precise and accurate VT delivery is difficult. Whereas neonatal ICU ventilators are validated in this population, thorough studies testing the performance of anesthesia ventilators in delivering small VT in neonates are lacking.METHODS: Three anesthesia ventilators, Dräger Apollo, GE Avance, and Getinge Flow-i; and 2 ICU ventilators, Medtronic PB980 and Nihon Kohden NKV-550, were tested under volume control mode at VT of 5, 20, 40, and 60 mL. Three combinations of lung compliance and airway resistance were tested using a Servo ASL 5000 lung simulator.RESULTS: In a scenario without leak, the measured VT was > the set VT by > 10% in the Apollo (21.0% [18.8–26.0]); measured VT was < the set VT by > 10% in the Flow-i (−19% [−20.8 to −18.7]). The Avance, PB980, and NKV-550 presented a volume error < 10% (−9.50% [−10.8 to −4.4], −5.8% [−11.8 to −3.5], and 5.4% [−4.5 to 18.9], respectively). Considering all combinations of set VT, leaks, and respiratory mechanics, none of the anesthesia ventilators were able to deliver a median measured VT within a 10% error. The bias between measured VT and set VT varied widely among ventilators (from 4.27 mL to −10.59 mL). Additionally, in the Apollo ventilator, PEEP was underdelivered with the largest leak value.CONCLUSIONS: Our results suggest that in comparison with the 2 neonatal ICU ventilators tested, the anesthesia ventilators did not greatly differ in terms of VT delivery in the presence of a gas leak.