Intensive Care Medicine

, Volume 36, Issue 12, pp 2053–2059 | Cite as

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

  • Laurence Vignaux
  • Didier Tassaux
  • Guillaume Carteaux
  • Jean Roeseler
  • Lise Piquilloud
  • Laurent Brochard
  • Philippe Jolliet
Original

Abstract

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.

Keywords

Noninvasive ventilation Mechanical ventilation Patient-ventilator interaction Asynchrony 

Supplementary material

134_2010_1994_MOESM1_ESM.doc (50 kb)
Supplementary material 1 (DOC 49 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Laurence Vignaux
    • 1
    • 2
  • Didier Tassaux
    • 1
    • 2
  • Guillaume Carteaux
    • 3
  • Jean Roeseler
    • 4
  • Lise Piquilloud
    • 1
    • 2
  • Laurent Brochard
    • 3
    • 5
    • 6
  • Philippe Jolliet
    • 7
    • 8
  1. 1.Service des Soins IntensifsHôpitaux universitaires de GenèveGenevaSwitzerland
  2. 2.Faculté de médecineUniversité de GenèveGenevaSwitzerland
  3. 3.Réanimation médicale, AP-HPCentre hospitalier Albert Chenevier-Henri-MondorCréteilFrance
  4. 4.Service des Soins IntensifsCliniques Universitaires St.-LucBrusselsBelgium
  5. 5.INSERM U 955CréteilFrance
  6. 6.Université Paris 12CréteilFrance
  7. 7.Service de Médecine Intensive Adulte et Centre des brûlésCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  8. 8.Faculté de biologie et de médecineUniversité de LausanneLausanneSwitzerland

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