Accuracy of P0.1 measurements performed by ICU ventilators: a bench study

Annals of Intensive Care

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[1] 0000 0001 2248 3363, grid.7252.2, Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, 4 rue Larrey, 49933, Angers Cedex 9, France;0000 0001 2248 3363, grid.7252.2, Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, 4 rue Larrey, 49933, Angers Cedex 9, France;0000 0001 2165 4204, grid.9851.5, Adult Intensive Care and Burn Unit, University Hospital and University of Lausanne, Lausanne, Switzerland;0000 0001 2248 3363, grid.7252.2, Medical Intensive Care Unit, University Hospital of Angers, UNIV Angers, 4 rue Larrey, 49933, Angers Cedex 9, France;0000 0004 1771 4456, grid.418061.a, Intensive Care Unit, General Hospital of Le Mans, Le Mans, France;SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France;grid.457369.a, INSERM, UMR 1066, Creteil, France;

关键词: Mechanical ventilation;    Occlusion pressure;    Respiratory drive;    Inspiratory effort;    Respiratory failure;   

DOI  :  10.1186/s13613-019-0576-x

来源: publisher

【 摘 要 】

BackgroundOcclusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators.MethodsFive ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1ref). The pressure drop after 100 ms was measured offline on the airway pressure–time curves recorded during the automated P0.1 measurements (P0.1aw). P0.1vent was compared to P0.1ref and to P0.1aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1circuit).ResultsVariations of P0.1vent correlated well with variations of P0.1ref. Overall, P0.1vent underestimated P0.1ref except for the Löwenstein® ventilator at P0.1ref 2.5 cm H2O and for the Getinge group® ventilator at P0.1ref 10 cm H2O. The agreement between P0.1vent and P0.1ref assessed with the Bland–Altman method gave a mean bias of − 1.3 cm H2O (limits of agreement: 1 and − 3.7 cm H2O). Analysis of airway pressure–time and flow–time curves showed that all the tested ventilators except the Getinge group® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1vent and P0.1aw assessed with the Bland–Altman method gave a mean bias of 0.5 cm H2O (limits of agreement: 2.4 and − 1.4 cm H2O). The circuit’s length impacted P0.1 measurements’ values. A longer circuit was associated with lower P0.1circuit values.ConclusionP0.1vent relative changes are well correlated to P0.1ref changes in all the tested ventilators. Accuracy of absolute values of P0.1vent varies according to the ventilator model. Overall, P0.1vent underestimates P0.1ref. The length of the circuit may partially explain P0.1vent underestimation.

【 授权许可】

CC BY