Intensive Care Medicine

, Volume 35, Issue 8, pp 1368–1376 | Cite as

A bench study of intensive-care-unit ventilators: new versus old and turbine-based versus compressed gas-based ventilators

  • Arnaud W. Thille
  • Aissam Lyazidi
  • Jean-Christophe M. Richard
  • Fabrice Galia
  • Laurent Brochard



To compare 13 commercially available, new-generation, intensive-care-unit (ICU) ventilators in terms of trigger function, pressurization capacity during pressure-support ventilation (PSV), accuracy of pressure measurements, and expiratory resistance.

Design and setting

Bench study at a research laboratory in a university hospital.


Four turbine-based ventilators and nine conventional servo-valve compressed-gas ventilators were tested using a two-compartment lung model. Three levels of effort were simulated. Each ventilator was evaluated at four PSV levels (5, 10, 15, and 20 cm H2O), with and without positive end-expiratory pressure (5 cm H2O). Trigger function was assessed as the time from effort onset to detectable pressurization. Pressurization capacity was evaluated using the airway pressure–time product computed as the net area under the pressure–time curve over the first 0.3 s after inspiratory effort onset. Expiratory resistance was evaluated by measuring trapped volume in controlled ventilation.


Significant differences were found across the ventilators, with a range of triggering delays from 42 to 88 ms for all conditions averaged (P < 0.001). Under difficult conditions, the triggering delay was longer than 100 ms and the pressurization was poor for five ventilators at PSV5 and three at PSV10, suggesting an inability to unload patient’s effort. On average, turbine-based ventilators performed better than conventional ventilators, which showed no improvement compared to a bench comparison in 2000.


Technical performance of trigger function, pressurization capacity, and expiratory resistance differs considerably across new-generation ICU ventilators. ICU ventilators seem to have reached a technical ceiling in recent years, and some ventilators still perform inadequately.


Mechanical ventilation Pressure-support ventilation Work of breathing Inspiratory trigger Bench study 

Supplementary material

134_2009_1467_MOESM1_ESM.doc (491 kb)
Supplementary material 1 (DOC 490 kb)


  1. 1.
    Tobin MJ, Jubran A, Laghi F (2001) Patient-ventilator interaction. Am J Respir Crit Care Med 163:1059–1063PubMedGoogle Scholar
  2. 2.
    Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, Gonzalez M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D’Empaire G, Sandi F, Matamis D, Montanez AM, Anzueto A (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 177:170–177PubMedCrossRefGoogle Scholar
  3. 3.
    Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMedGoogle Scholar
  4. 4.
    Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755PubMedCrossRefGoogle Scholar
  5. 5.
    Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRefGoogle Scholar
  6. 6.
    Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M (1997) Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest 112:1592–1599PubMedCrossRefGoogle Scholar
  7. 7.
    Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, Sinderby C (2001) Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 164:419–424PubMedGoogle Scholar
  8. 8.
    Parthasarathy S, Jubran A, Tobin MJ (1998) Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med 158:1471–1478PubMedGoogle Scholar
  9. 9.
    Richard JC, Carlucci A, Breton L, Langlais N, Jaber S, Maggiore S, Fougere S, Harf A, Brochard L (2002) Bench testing of pressure support ventilation with three different generations of ventilators. Intensive Care Med 28:1049–1057PubMedCrossRefGoogle Scholar
  10. 10.
    Jaber S, Tassaux D, Sebbane M, Pouzeratte Y, Battisti A, Capdevila X, Eledjam JJ, Jolliet P (2006) Performance characteristics of five new anesthesia ventilators and four intensive care ventilators in pressure-support mode: a comparative bench study. Anesthesiology 105:944–952PubMedCrossRefGoogle Scholar
  11. 11.
    Tassaux D, Strasser S, Fonseca S, Dalmas E, Jolliet P (2002) Comparative bench study of triggering, pressurization, and cycling between the home ventilator VPAP II and three ICU ventilators. Intensive Care Med 28:1254–1261PubMedCrossRefGoogle Scholar
  12. 12.
    Battisti A, Tassaux D, Janssens JP, Michotte JB, Jaber S, Jolliet P (2005) Performance characteristics of 10 home mechanical ventilators in pressure-support mode: a comparative bench study. Chest 127:1784–1792PubMedCrossRefGoogle Scholar
  13. 13.
    Bunburaphong T, Imanaka H, Nishimura M, Hess D, Kacmarek RM (1997) Performance characteristics of bilevel pressure ventilators: a lung model study. Chest 111:1050–1060PubMedCrossRefGoogle Scholar
  14. 14.
    Ferreira JC, Chipman DW, Kacmarek RM (2008) Trigger performance of mid-level ICU mechanical ventilators during assisted ventilation: a bench study. Intensive Care Med 34:1669–1675PubMedCrossRefGoogle Scholar
  15. 15.
    Aslanian P, El Atrous S, Isabey D, Valente E, Corsi D, Harf A, Lemaire F, Brochard L (1998) Effects of flow triggering on breathing effort during partial ventilatory support. Am J Respir Crit Care Med 157:135–143PubMedGoogle Scholar
  16. 16.
    Sassoon CS, Del Rosario N, Fei R, Rheeman CH, Gruer SE, Mahutte CK (1994) Influence of pressure- and flow-triggered synchronous intermittent mandatory ventilation on inspiratory muscle work. Crit Care Med 22:1933–1941PubMedCrossRefGoogle Scholar
  17. 17.
    Mancebo J, Amaro P, Mollo JL, Lorino H, Lemaire F, Brochard L (1995) Comparison of the effects of pressure support ventilation delivered by three different ventilators during weaning from mechanical ventilation. Intensive Care Med 21:913–919PubMedCrossRefGoogle Scholar
  18. 18.
    Bonmarchand G, Chevron V, Chopin C, Jusserand D, Girault C, Moritz F, Leroy J, Pasquis P (1996) Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med 22:1147–1154PubMedCrossRefGoogle Scholar
  19. 19.
    Bonmarchand G, Chevron V, Menard JF, Girault C, Moritz-Berthelot F, Pasquis P, Leroy J (1999) Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients. Crit Care Med 27:715–722PubMedCrossRefGoogle Scholar
  20. 20.
    Chiumello D, Pelosi P, Croci M, Bigatello LM, Gattinoni L (2001) The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation. Eur Respir J 18:107–114PubMedCrossRefGoogle Scholar
  21. 21.
    Lyazidi A, Galia F, Thille AW, Di Marco F, Rodriguez P, Brochard L (2006) Performance of intensive care unit ventilators during pressure support ventilation mode: a bench study. Intensive Care Med 32:A0337Google Scholar
  22. 22.
    Sassoon CS, Mahutte CK, Te TT, Simmons DH, Light RW (1988) Work of breathing and airway occlusion pressure during assist-mode mechanical ventilation. Chest 93:571–576PubMedCrossRefGoogle Scholar
  23. 23.
    Berger KI, Sorkin IB, Norman RG, Rapoport DM, Goldring RM (1996) Mechanism of relief of tachypnea during pressure support ventilation. Chest 109:1320–1327PubMedCrossRefGoogle Scholar
  24. 24.
    Cinnella G, Conti G, Lofaso F, Lorino H, Harf A, Lemaire F, Brochard L (1996) Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Crit Care Med 153:1025–1033PubMedGoogle Scholar
  25. 25.
    Branson RD, Campbell RS, Davis K Jr, Johnson DJ II (1994) Comparison of pressure and flow triggering systems during continuous positive airway pressure. Chest 106:540–544PubMedCrossRefGoogle Scholar
  26. 26.
    Sassoon CS, Gruer SE (1995) Characteristics of the ventilator pressure- and flow-trigger variables. Intensive Care Med 21:159–168PubMedCrossRefGoogle Scholar
  27. 27.
    Giuliani R, Mascia L, Recchia F, Caracciolo A, Fiore T, Ranieri VM (1995) Patient-ventilator interaction during synchronized intermittent mandatory ventilation. Effects of flow triggering. Am J Respir Crit Care Med 151:1–9PubMedGoogle Scholar
  28. 28.
    Ranieri VM, Mascia L, Petruzzelli V, Bruno F, Brienza A, Giuliani R (1995) Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med 21:896–903PubMedCrossRefGoogle Scholar
  29. 29.
    Miyoshi E, Fujino Y, Mashimo T, Nishimura M (2000) Performance of transport ventilator with patient-triggered ventilation. Chest 118:1109–1115PubMedCrossRefGoogle Scholar
  30. 30.
    Zanetta G, Robert D, Guerin C (2002) Evaluation of ventilators used during transport of ICU patients—a bench study. Intensive Care Med 28:443–451PubMedCrossRefGoogle Scholar
  31. 31.
    Vignaux L, Tassaux D, Jolliet P (2007) Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study. Intensive Care Med 33:1444–1451PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Arnaud W. Thille
    • 1
    • 2
    • 3
  • Aissam Lyazidi
    • 1
    • 2
    • 3
  • Jean-Christophe M. Richard
    • 4
    • 5
  • Fabrice Galia
    • 1
    • 2
    • 3
  • Laurent Brochard
    • 1
    • 2
    • 3
  1. 1.Medical Intensive Care Unit, AP-HPCentre Hospitalier Albert Chenevier-Henri Mondor HospitalCreteilFrance
  2. 2.INSERM U955 (team 13)CreteilFrance
  3. 3.University of Paris 12CreteilFrance
  4. 4.Medical Intensive Care UnitHôpital Universitaire Charles NicolleRouenFrance
  5. 5.UPRES EA3830RouenFrance

Personalised recommendations