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Original Research: CRITICAL CARE MEDICINE |

Intentional Leaks in Industrial Masks Have a Significant Impact on Efficacy of Bilevel Noninvasive Ventilation: A Bench Test Study

Jean Christian Borel, PhD; AbdelKebir Sabil, PhD; Jean-Paul Janssens, MD; Marie Couteau, MSc; Loren Boulon, MSc; Patrick Lévy, MD, PhD; Jean-Louis Pépin, MD, PhD
Author and Funding Information

*From the Pole Rééducation et Physiologie, CHU de Grenoble, et Laboratoire HP2 (Drs. Borel, Lévy, and Pépin), INSERM ERI 0017, Université Joseph Fourier, Grenoble, France; the Association Médico-Technique AGIR à Dom (Dr. Sabil and Ms. Boulon), Meylan, France; the Service de Pneumologie (Dr. Janssens), Hôpital Cantonal Universitaire, Genève, Suisse; and the Société AIROX (Ms. Couteau), Groupe COVIDIEN, Pau, France.

Correspondence to: Jean-Louis Pépin, MD, PhD, Laboratoire EFCR, CHU de Grenoble, BP217X, 38043 Grenoble Cedex 09, France; e-mail: JPepin@chu-grenoble.fr


The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):669-677. doi:10.1378/chest.08-1340
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Background:  During noninvasive ventilation, nonintentional leaks have a detrimental effect on the efficacy of ventilation. A wide range of industrial masks are available, with intentional leaks of different importance. The potential impact of this variability in intentional leaks on performances of bilevel ventilators has not been assessed.

Objective:  To measure intentional leaks in seven different industrial masks and determine whether higher leaks modify ventilator performance and quality of ventilation.

Methods:  Seven interfaces connected to four ventilators, the VPAP III ST (ResMed; NorthRyde, Australia), the BiPAP Harmony (Respironics; Monroeville, PA), the SmartAir ST (Covidien/Airox; Pau, France), and the GoodKnight 425 ST Bilevel (Covidien/Tyco-Nellcor/Puritan Bennett; Pleasanton, CA), were adapted on a mannequin connected to a lung model (ASL5000, IngMar Medical; Pittsburgh, PA). Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure were 14 and 4 cm H2O, respectively. The lung model was set with a respiratory rate of 15 cycles per min and a duration of inspiration of 1 s in three simulated conditions (normal, restrictive, and obstructive). Inspiratory trigger delay and effort, capacity to achieve and maintain IPAP, expiratory cycling and tidal volume were analyzed for all masks and ventilators in the three simulated lung conditions.

Results:  The level of intentional leaks in the seven masks ranged from 30 to 45 L/min for an IPAP of 14 cm H2O. Importance of leaks did not influence trigger performances. However, capacity to achieve and maintain IPAP was significantly decreased with all ventilators and in all simulated lung conditions when intentional leaks increased. This led to a maximum reduction in delivered tidal volume of 48 mL. Expiratory cycling was not affected by the level of intentional leaks except in obstructive lung conditions.

Conclusion:  Mask intentional leaks can impair efficacy of ventilation, especially when > 40 L/min.

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