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Monitoring Noninvasive Ventilation of Home Bilevel VentilatorsMonitoring Home Bilevel Ventilators: Are Bench Studies More Necessary and Familiar? FREE TO VIEW

Antonio M. Esquinas Rodríguez, MD, PhD; Bebiana Conde, MD; Alan R. Schwartz, MD
Author and Funding Information

From the Intensive Care Unit (Dr Esquinas), Hospital Morales Meseguer; the Division of Pulmonary and Sleep Disorders Center (Dr Conde), Centro Hospitalar de Trás-os-Montes e Alto Douro; and the Johns Hopkins Sleep Disorders Center at Bayview Campus (Dr Schwartz), Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.

Correspondence to: Antonio M. Esquinas Rodríguez, MD, PhD, Intensive Care Unit, Hospital Morales Meseguer, Avenida Marques de Los Velez, s/n, Murcia, 3088, Spain; e-mail: antmesquinas@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1692-1693. doi:10.1378/chest.12-1664
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To the Editor:

Noninvasive bilevel positive-pressure ventilators provide physicians with software that records parameters important for patient monitoring, although the validity of this information has not yet been independently assessed.1 In an article in CHEST (February 2012), Contal et al2 developed a bench test system to assess the performance of seven home bilevel ventilators and compared leaks and tidal volume (Vt) from bench test data with results retrieved from the ventilator software. Testing was performed on a bench model adapted to simulate noninvasive ventilation and generate unintentional leaks. Five levels of leaks were simulated using a computer-driven solenoid valve at different levels of pressure.

Interestingly, these investigators found that three of the devices (Trilogy [Philips Respironics], VPAP III ST and VPAP IV ST-A [ResMed]) provided highly reliable estimates of leak flow, with a small bias and narrow limits of agreement, and high correlations between ventilator software and bench results. Moreover, as leaks increased, ventilator auto-triggering occurred in two of these devices (Ventimotion [Weinmann Medical Technology GmBH & Co KG] with maximal respiratory rate [RR] recorded at 25 cycles/min, and Vivo 40 [Breas Medical AB] with a maximal RR recorded at 19 cycles/min). Vt was underestimated by all devices, and bias increased (range, 66-236 mL) with higher inspiratory pressures. Synchrony (Philips Respironics) and Trilogy demonstrated consistently low Vt bias of <100 mL in all test conditions. The relationship between ΔVt and leaks was not significant for Monnal T30 (Air Liquide), Trilogy, and Ventimotion; was positive in Vivo 40; and was inversely related in the Synchrony, VPAP III ST, and VPAP IV ST-A.2 These results led Contal et al2 to suggest that considerable variability may be encountered in estimates of respiratory parameters from data obtained with software in seven commonly used domiciliary ventilators.

We consider and support that despite considerable evidence to suggest that monitoring can significantly impact noninvasive ventilation effectiveness, the current study provides long-needed objective data to establish the reliability of leak and Vt estimates from different ventilators. In monitoring home noninvasive ventilation, we usually use information provided by the ventilators’ software (eg, Vt, RR, minute ventilation, residual events index), pulse oximetry, capnography, and telemedicine devices.3-5 Thus, Contal et al2 provide important insight, suggesting that differences in equipment and pressure profiles can influence leaks and Vt estimates significantly. Resulting inaccuracies can contribute to variability in patient tolerance, adherence, and effectiveness and ultimately influence long-term outcomes, such as quality of life and survival. It is incumbent upon the clinician to become familiar with performance characteristics of those ventilators best suited to address the specific needs of patients.1,2,5

References

Scala R. Bi-level home ventilators for non invasive positive pressure ventilation. Monaldi Arch Chest Dis. 2004;61(4):213-221. [PubMed]
 
Contal O, Vignaux L, Combescure C, Pepin J-L, Jolliet P, Janssens J-P. Monitoring of noninvasive ventilation by built-in software of home bilevel ventilators: a bench study. Chest. 2012;141(2):469-476. [CrossRef] [PubMed]
 
Luján M, Sogo A, Monsó E. Home mechanical ventilation monitoring software: measure more or measure better?. Arch Bronconeumol. 2012;48(5):170-178. [CrossRef] [PubMed]
 
Pasquina P, Adler D, Farr P, Bourqui P, Bridevaux PO, Janssens JP. What does built-in software of home ventilators tell us? An observational study of 150 patients on home ventilation. Respiration. 2012;83(4):293-299. [CrossRef] [PubMed]
 
Blakeman TC, Rodriquez D Jr, Hanseman D, Branson RD. Bench evaluation of 7 home-care ventilators. Respir Care. 2011;56(11):1791-1798. [CrossRef] [PubMed]
 

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References

Scala R. Bi-level home ventilators for non invasive positive pressure ventilation. Monaldi Arch Chest Dis. 2004;61(4):213-221. [PubMed]
 
Contal O, Vignaux L, Combescure C, Pepin J-L, Jolliet P, Janssens J-P. Monitoring of noninvasive ventilation by built-in software of home bilevel ventilators: a bench study. Chest. 2012;141(2):469-476. [CrossRef] [PubMed]
 
Luján M, Sogo A, Monsó E. Home mechanical ventilation monitoring software: measure more or measure better?. Arch Bronconeumol. 2012;48(5):170-178. [CrossRef] [PubMed]
 
Pasquina P, Adler D, Farr P, Bourqui P, Bridevaux PO, Janssens JP. What does built-in software of home ventilators tell us? An observational study of 150 patients on home ventilation. Respiration. 2012;83(4):293-299. [CrossRef] [PubMed]
 
Blakeman TC, Rodriquez D Jr, Hanseman D, Branson RD. Bench evaluation of 7 home-care ventilators. Respir Care. 2011;56(11):1791-1798. [CrossRef] [PubMed]
 
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