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Original Research: CRITICAL CARE MEDICINE |

Bilevel vs ICU Ventilators Providing Noninvasive Ventilation: Effect of System Leaks: A COPD Lung Model Comparison

Juliana C. Ferreira, MD; Daniel W. Chipman, RRT; Nicholas S. Hill, MD, FCCP; Robert M. Kacmarek, PhD, RRT
Author and Funding Information

From the Departments of Anesthesia and Critical Care (Dr. Ferreira) and Respiratory Care (Mr. Chipman and Dr. Kacmarek), Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil; Instituto do Coração (Dr. Ferreira), Sao Paulo, Brazil; Tufts University School of Medicine (Dr. Hill), Boston, MA; and Harvard Medical School (Dr. Kacmarek), Boston, MA.

Robert Kacmarek, PhD, RRT, Respiratory Care Services, Ellison 401, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; e-mail: rkacmarek@partners.org


This study was partially funded by an unrestricted grant from Respironics Inc. Dr. Ferreira was partially funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(2):448-456. doi:10.1378/chest.08-3018
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Background:  Noninvasive positive-pressure ventilation (NPPV) modes are currently available on bilevel and ICU ventilators. However, little data comparing the performance of the NPPV modes on these ventilators are available.

Methods:  In an experimental bench study, the ability of nine ICU ventilators to function in the presence of leaks was compared with a bilevel ventilator using the IngMar ASL5000 lung simulator (IngMar Medical; Pittsburgh, PA) set at a compliance of 60 mL/cm H2O, an inspiratory resistance of 10 cm H2O/L/s, an expiratory resistance of 20 cm H2O/ L/s, and a respiratory rate of 15 breaths/min. All of the ventilators were set at 12 cm H2O pressure support and 5 cm H2O positive end-expiratory pressure. The data were collected at baseline and at three customized leaks.

Main results:  At baseline, all of the ventilators were able to deliver adequate tidal volumes, to maintain airway pressure, and to synchronize with the simulator, without missed efforts or auto-triggering. As the leak was increased, all of the ventilators (except the Vision [Respironics; Murrysville, PA] and Servo I [Maquet; Solna, Sweden]) needed adjustment of sensitivity or cycling criteria to maintain adequate ventilation, and some transitioned to backup ventilation. Significant differences in triggering and cycling were observed between the Servo I and the Vision ventilators.

Conclusions:  The Vision and Servo I were the only ventilators that required no adjustments as they adapted to increasing leaks. There were differences in performance between these two ventilators, although the clinical significance of these differences is unclear. Clinicians should be aware that in the presence of leaks, most ICU ventilators require adjustments to maintain an adequate tidal volume.

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