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Original Research: RESPIRATORY CARE |

Monitoring of Noninvasive Ventilation by Built-in Software of Home Bilevel VentilatorsEvaluation of Software of Home Ventilators: A Bench Study

Olivier Contal, MS PT; Laurence Vignaux, MS PT; Christophe Combescure, PhD; Jean-Louis Pepin, MD, PhD; Philippe Jolliet, MD; Jean-Paul Janssens, MD
Author and Funding Information

From the Division of Pulmonary Diseases (Mr Contal and Dr Janssens), the Intensive Care Unit (Ms Vignaux), and CRC & Division of Cinical-Epidemiology, Department of Health and Community Medicine (Dr Combescure), Geneva University Hospital, Geneva, Switzerland; the Institut National de la Sante et de la Recherche Médicale, Unit 1042 (Dr Pepin), University Hospital, Grenoble, France; the SomnoNIV Group (Drs Pepin and Janssens); and the Intensive Care Unit (Dr Jolliet) University Hospital of Lausanne, Switzerland.

Correspondence to: Olivier Contal, MS PT, Centre antituberculeux, Hôpital Cantonal Universitaire, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; e-mail: Olivier.Contal@hcuge.ch


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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


© 2012 American College of Chest Physicians


Chest. 2012;141(2):469-476. doi:10.1378/chest.11-0485
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Background:  Current bilevel positive-pressure ventilators for home noninvasive ventilation (NIV) provide physicians with software that records items important for patient monitoring, such as compliance, tidal volume (Vt), and leaks. However, to our knowledge, the validity of this information has not yet been independently assessed.

Methods:  Testing was done for seven home ventilators on a bench model adapted to simulate NIV and generate unintentional leaks (ie, other than of the mask exhalation valve). Five levels of leaks were simulated using a computer-driven solenoid valve (0-60 L/min) at different levels of inspiratory pressure (15 and 25 cm H2O) and at a fixed expiratory pressure (5 cm H2O), for a total of 10 conditions. Bench data were compared with results retrieved from ventilator software for leaks and Vt.

Results:  For assessing leaks, three of the devices tested were highly reliable, with a small bias (0.3-0.9 L/min), narrow limits of agreement (LA), and high correlations (R2, 0.993-0.997) when comparing ventilator software and bench results; conversely, for four ventilators, bias ranged from −6.0 L/min to −25.9 L/min, exceeding −10 L/min for two devices, with wide LA and lower correlations (R2, 0.70-0.98). Bias for leaks increased markedly with the importance of leaks in three devices. Vt was underestimated by all devices, and bias (range, 66-236 mL) increased with higher insufflation pressures. Only two devices had a bias < 100 mL, with all testing conditions considered.

Conclusions:  Physicians monitoring patients who use home ventilation must be aware of differences in the estimation of leaks and Vt by ventilator software. Also, leaks are reported in different ways according to the device used.

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