Intensive Care Medicine

, Volume 36, Issue 4, pp 688–691 | Cite as

Bilevel positive airway pressure ventilation: factors influencing carbon dioxide rebreathing

  • Zbigniew Szkulmowski
  • Kheirallah Belkhouja
  • Quoc-Hung Le
  • Dominique Robert
  • Laurent Argaud
Brief Report

Abstract

Purpose

Use of bilevel positive airway pressure (BLPAP) ventilators for noninvasive ventilation (NIV) is an established treatment for both acute and chronic ventilatory failure. Although BLPAP ventilator circuits are simpler than those of conventional ventilators, one drawback to their use is that they allow variable amounts of rebreathing to occur. The aim of this work is to measure the amount of CO2 reinsufflated in relation to the BLPAP ventilator circuit in patients, and to determine predictive factors for rebreathing.

Methods

Eighteen adult patients were ventilated on pressure support, either by intubation or with mask ventilation, during a weaning period. The mean inspiratory fraction of CO2 (tidal FiCO2) reinsufflated from the circuit between the intentional leak and the ventilator was measured for each breath. The influence of end-tidal CO2 concentration (ETCO2), respiratory rate (RR), percentage of inspiratory time (Ti/TTOT), application of expiratory positive airway pressure (EPAP), and inspiratory tidal volume on magnitude of tidal FiCO2, as well as the influence of intubation versus NIV, were studied by univariate comparisons and logistic regression analysis.

Results

In a total of 11,107 cycles, tidal FiCO2 was 0.072 ± 0.173%. Of fractions measured, 8,976 (81%) were under 0.10% and 2,131 (19%) were over 0.10%, with mean values of 0.026 ± 0.027% and 0.239 ± 0.326%, respectively. ETCO2, EPAP, NIV versus intubation, and RR had significant predictive value for tidal FiCO2 >0.10%.

Conclusions

BLPAP ventilators present a specific rebreathing risk to patients. However, that risk remains modest, even in intubated patients, provided that EPAP is applied.

Keywords

Bilevel positive airway pressure ventilation Carbon dioxide Expiratory positive airway pressure ICU Rebreathing 

References

  1. 1.
    Sanders MH, Kern N (1990) Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest 98:317–324CrossRefPubMedGoogle Scholar
  2. 2.
    Strumpf DA, Millman RP, Carlisle CC, Grattan LM, Ryan SM, Erickson AD, Hill NS (1990) An evaluation of the Respironics BiPAP bi-level CPAP device for delivery of assisted ventilation. Respir Care 35:415–422Google Scholar
  3. 3.
    Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D (1996) Home versus intensive care pressure support devices. Experimental and clinical comparison. Am J Respir Crit Care Med 153:1591–1599PubMedGoogle Scholar
  4. 4.
    Pennock BE, Crawshaw L, Kaplan PD (1994) Noninvasive nasal mask ventilation for acute respiratory failure. Institution of a new therapeutic technology for routine use. Chest 105:441–444CrossRefPubMedGoogle Scholar
  5. 5.
    Pollack C Jr, Torres MT, Alexander L (1996) Feasibility study of the use of bilevel positive airway pressure for respiratory support in the emergency department. Ann Emerg Med 27:189–192CrossRefPubMedGoogle Scholar
  6. 6.
    Auriant I, Jallot A, Herve P, Cerrina J, Le Roy Ladurie F, Fournier JL, Lescot B, Parquin F (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235PubMedGoogle Scholar
  7. 7.
    Cross AM, Cameron P, Kierce M, Ragg M, Kelly AM (2003) Non-invasive ventilation in acute respiratory failure: a randomised comparison of continuous positive airway pressure and bi-level positive airway pressure. Emerg Med J 20:531–534CrossRefPubMedGoogle Scholar
  8. 8.
    Lloyd-Owen SJ, Donaldson GC, Ambrosino N, Escarabill J, Farre R, Fauroux B, Robert D, Schoenhofer B, Simonds AK, Wedzicha JA (2005) Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J 25:1025–1031CrossRefPubMedGoogle Scholar
  9. 9.
    Caples SM, Gay PC (2005) Noninvasive positive pressure ventilation in the intensive care unit: a concise review. Crit Care Med 33:2651–2658CrossRefPubMedGoogle Scholar
  10. 10.
    Patel RG, Petrini MF (1998) Respiratory muscle performance, pulmonary mechanics, and gas exchange between the BiPAP S/T-D system and the Servo Ventilator 900C with bilevel positive airway pressure ventilation following gradual pressure support weaning. Chest 114:1390–1396CrossRefPubMedGoogle Scholar
  11. 11.
    Schettino GP, Chatmongkolchart S, Hess DR, Kacmarek RM (2003) Position of exhalation port and mask design affect CO2 rebreathing during noninvasive positive pressure ventilation. Crit Care Med 31:2178–2182CrossRefPubMedGoogle Scholar
  12. 12.
    Lofaso F, Brochard L, Touchard D, Hang T, Harf A, Isabey D (1995) Evaluation of carbon dioxide rebreathing during pressure support ventilation with airway management system (BiPAP) devices. Chest 108:772–778CrossRefPubMedGoogle Scholar
  13. 13.
    Ferguson GT, Gilmartin M (1995) CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med 151:1126–1135PubMedGoogle Scholar
  14. 14.
    Hill NS, Carlisle C, Kramer NR (2002) Effect of a nonrebreathing exhalation valve on long-term nasal ventilation using a bilevel device. Chest 122:84–91CrossRefPubMedGoogle Scholar
  15. 15.
    Scheid P, Lofaso F, Isabey D, Harf A (1994) Respiratory response to inhaled CO2 during positive inspiratory pressure in humans. J Appl Physiol 77:876–882PubMedGoogle Scholar
  16. 16.
    Georgopoulos D, Mitrouska I, Bshouty Z, Webster K, Patakas D, Younes M (1997) Respiratory response to CO2 during pressure-support ventilation in conscious normal humans. Am J Respir Crit Care Med 156:146–154PubMedGoogle Scholar
  17. 17.
    Lucangelo U, Blanch L (2004) Dead space. Intensive Care Med 30:576–579CrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Zbigniew Szkulmowski
    • 1
  • Kheirallah Belkhouja
    • 2
  • Quoc-Hung Le
    • 3
  • Dominique Robert
    • 2
    • 4
  • Laurent Argaud
    • 2
  1. 1.Katedra i Klinika Anestezjologii Intensywnej Terapii, Szpital Uniwersytecki w BydgoszczyCollegium Medicum w Bydgoszczy Uniwersytet Mikolaja Kopernika w ToruniuBydgoszczPoland
  2. 2.Medical Intensive Care, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon-Nord Medical SchoolUniversity Claude Bernard Lyon ILyonFrance
  3. 3.Department of BiostatisticsHospices Civils de Lyon, Groupement Hospitalier Lyon-SudPierre-BéniteFrance
  4. 4.Service de Réanimation MédicaleLyon Cedex 03France

Personalised recommendations