Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study

• Published in: Intensive care medicine Vol. 36; no. 12; pp. 2053 - 2059
• Main Authors: Vignaux, Laurence, Tassaux, Didier, Carteaux, Guillaume, Roeseler, Jean, Piquilloud, Lise, Brochard, Laurent, Jolliet, Philippe
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2010; Springer; Springer Nature B.V
• Subjects: Acute Disease; Acute respiratory distress syndrome; Aged; Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Clinical trials; Critical Care Medicine; Cross-Over Studies; Emergency and intensive respiratory care; Emergency Medicine; Female; Humans; Intensive; Intensive care; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Medicine; Medicine & Public Health; Original; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Positive-Pressure Respiration - adverse effects; Prospective Studies; Respiratory failure; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - therapy; Ventilators; France; Switzerland; Noninvasive ventilation; Asynchrony; Patient-ventilator interaction; Mechanical ventilation; Human; Ventilator; Intensive care; Algorithm performance; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1994-2

Objective To evaluate the impact of noninvasive ventilation (NIV) algorithms available on intensive care unit ventilators on the incidence of patient-ventilator asynchrony in patients receiving NIV for acute respiratory failure. Design Prospective multicenter randomized cross-over study. Setting Intensive care units in three university hospitals. Methods Patients consecutively admitted to the ICU and treated by NIV with an ICU ventilator were included. Airway pressure, flow and surface diaphragmatic electromyography were recorded continuously during two 30-min periods, with the NIV (NIV+) or without the NIV algorithm (NIV0). Asynchrony events, the asynchrony index (AI) and a specific asynchrony index influenced by leaks (AIleaks) were determined from tracing analysis. Results Sixty-five patients were included. With and without the NIV algorithm, respectively, auto-triggering was present in 14 (22%) and 10 (15%) patients, ineffective breaths in 15 (23%) and 5 (8%) ( p  = 0.004), late cycling in 11 (17%) and 5 (8%) ( p  = 0.003), premature cycling in 22 (34%) and 21 (32%), and double triggering in 3 (5%) and 6 (9%). The mean number of asynchronies influenced by leaks was significantly reduced by the NIV algorithm ( p  < 0.05). A significant correlation was found between the magnitude of leaks and AIleaks when the NIV algorithm was not activated ( p  = 0.03). The global AI remained unchanged, mainly because on some ventilators with the NIV algorithm premature cycling occurs. Conclusion In acute respiratory failure, NIV algorithms provided by ICU ventilators can reduce the incidence of asynchronies because of leaks, thus confirming bench test results, but some of these algorithms can generate premature cycling.