Comparative evaluation of three interfaces for non-invasive ventilation: a randomized cross-over design physiologic study on healthy volunteersReport as inadecuate




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Critical Care

, 18:R2

First Online: 03 January 2014Received: 11 December 2012Accepted: 27 November 2013

Abstract

IntroductionInterface choice is crucial for non-invasive ventilation NIV success. We compared a new interface, the helmet next HN, with the facial mask FM and the standard helmet HS in twelve healthy volunteers.

MethodsIn this study, five NIV trials were randomly applied, preceded and followed by a trial of unassisted spontaneous breathing SB. Baseline settings, for example, 5 cmH2O of both inspiratory pressure support PS and positive end-expiratory pressure PEEP, were applied through FM, HS and HN, while increased settings PS and PEEP of 8 cmH2O were only applied through HS and HN. We measured flow, airway, esophageal and gastric pressures, and calculated inspiratory effort indexes and trigger delays. Comfort was assessed with a visual-analog-scale.

ResultsWe found that FM, HS and HN at baseline settings were not significantly different with respect to inspiratory effort indexes and comfort. Inspiratory trigger delay and time of synchrony TI,synchrony were significantly improved by FM compared to both helmets, whereas expiratory trigger delay was shorter with FM, as opposed to HS only. HN at increased settings performed better than FM in decreasing inspiratory effort measured by pressure-time product of transdiaphragmatic pressure PTPdi-breath 10.7 ± 9.9 versus 17.0 ± 11.0 cmH2O*s, and PTPdi-min 128 ± 96 versus 204 ± 81 cmH2O*s-min, and PTPdi-L 12.6 ± 9.9 versus 30.2 ± 16.8 cmH2O*s-L. TI, synchrony was inferior between HN and HS at increased settings and FM.

ConclusionsHN might hold some advantages with respect to interaction and synchrony between subject and ventilator, but studies on patients are needed to confirm these findings.

Trial registrationClinicalTrials.gov NCT01610960

AbbreviationsDelayTR-exp: expiratory trigger delay

DelayTR-insp: inspiratory trigger delay

FiO2inspired oxygen fraction

FMface mask

HNhelmet next

HRheart rate

HShelmet standard

NIVnonivasive ventilation

Paopressure at the airway opening

Pditransdiaphragmatic pressure

PEEPpositive end-expiratory pressure

Pesesophageal pressure

Pgagastric pressure

PSpressure support

PSVpressure support ventilation

PTPdipressure-time product of transdiaphragmatic pressure

RRrespiratory rate

RRnpatient’s neural respiratory rate

RRvventilator rate of cycling

SBspontaneous breathing

SBEend spontaneous breathing

SBIinitial spontaneous breathing

SpO2pulse arterial oxygen saturation

TIp: patient’s inspiratory time

TIsynchrony: time of synchrony

TIv: ventilator’s inspiratory time

VASvisual analog scale

VEminute ventilation

VTtidal volume

WOBwork of breathing.

Electronic supplementary materialThe online version of this article doi:10.1186-cc13175 contains supplementary material, which is available to authorized users.

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Author: Rosanna Vaschetto - Audrey De Jong - Matthieu Conseil - Fabrice Galia - Martin Mahul - Yannael Coisel - Albert Prades - Pao

Source: https://link.springer.com/



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