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Non-invasive Ventilation: Effect of Vented and Non-vented Exhalation Systems on Inspiratory CO2 and O2 Concentrations, Ventilation, and Breathing Pattern

  • NON-INVASIVE VENTILATION
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Abstract

Introduction

To increase CO2 elimination and to reduce work of breathing in hypercapnic patients, non-invasive ventilation (NIV) can be applied via mask either with non-vented CO2 exhalation systems or with vented systems with leak port. The effect of the exhalation system on CO2 rebreathing in the mask and total gas exchange remains widely unknown. Aim of this study was to compare the exhalation systems in terms of inspiratory O2 and CO2 concentrations, breathing patterns and gas exchange.

Methods

We prospectively examined 10 healthy subjects and 10 hypercapnic patients with both exhalation systems. O2 and CO2 were measured in the nose, in the mask, and in the ventilation circuit, and respiratory rate, tidal volume, and transcutaneous capnometry (PtcCO2) were recorded during the experiments.

Results

Using the non-vented system, CO2 concentrations in the mask were significantly higher in both subject groups, and PtcCO2 values in the patient group increased up to 3.6 mmHg compared to the vented system (p = 0.011). O2 concentrations increased with higher O2 flow rates, but were significantly lower in the vented settings in both groups. No effect in breathing pattern could be demonstrated during the measurement time.

Conclusion

Using NIV, the chosen exhalation system influences CO2 and O2 concentrations under the mask, CO2 rebreathing from the mask and could influence the effectiveness of the ventilation support with regards to hypercapnia treatment. To compensate for relevant hypoxia, the O2 supplementation must be set up to a sufficient level under a vented system.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany

    Karl-Josef Franke, Barbara Dewald & Georg Nilius

  2. Kliniken Essen-Mitte, Essen, Germany

    Maik Schroeder, Ulrike Domanski & Georg Nilius

  3. Märkische Kliniken GmbH, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515, Lüdenscheid, Germany

    Karl-Josef Franke

Authors
  1. Karl-Josef Franke
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  2. Maik Schroeder
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  3. Ulrike Domanski
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  4. Barbara Dewald
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  5. Georg Nilius
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Contributions

KJF: draft of the article, conception and design, analysis and interpretation of data, critical review, final approval. GN, MS, BD, UD: conception and design, analysis and interpretation of data, critical review, draft correction and proof reading, final approval.

Corresponding author

Correspondence to Karl-Josef Franke.

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Conflict of interest

KJ Franke, M Schroeder, U Domanski, and B Dewald have no financial or other potential conflicts of interest associated with this study. G Nilius has received research support from Fisher & Paykel Healthcare, Heinen und Löwenstein, ResMed and Weinmann; this has gone into department funds.

Ethical Approval

The study was approved under Nr 13/2014 of the ethics committee of University Witten/Herdecke.

Informed Consent

Informed consent was obtained from all individual participants. The study was already presented at the European Respiratory Society (KJ Franke, U Domanski, M Schroeder, B Stoehr, G Nilius. Non-invasive ventilation: Effect of a vented and a non-vented CO2 exhalation system on O2- and CO2-concentration. European Respiratory Journal 2016 48: OA3533; https://doi.org/10.1183/13993003.congress-2016.OA3533).

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Franke, KJ., Schroeder, M., Domanski, U. et al. Non-invasive Ventilation: Effect of Vented and Non-vented Exhalation Systems on Inspiratory CO2 and O2 Concentrations, Ventilation, and Breathing Pattern. Lung 200, 251–260 (2022). https://doi.org/10.1007/s00408-022-00520-7

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  • DOI: https://doi.org/10.1007/s00408-022-00520-7

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