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* From the Intensive Care Unit (Drs. Miyoshi, Fujino, Mashimo, and Nishimura) and Department of Anesthesiology (Dr. Mashimo), Osaka University Hospital, Osaka Japan.
Correspondence to: Yuji Fujino, MD, Intensive Care Unit, Osaka University Hospital, 2–15, Yamadaoka, Suita, Osaka, Japan 565-0871; e-mail: fujino{at}hp-icu.med.osaka-u.ac.jp
Objectives: Transport ventilators with inspiratory triggering functions and pressure support–control modes have recently become commercially available. We evaluated these ventilators in comparison with a standard ICU ventilator.
Study design: Laboratory study with a mechanical lung model.
Methods: We compared the performance of four transport
ventilators (model 740, Mallinckrodt, Pleasanton, CA; TBird, Bird
Products Corp, Palm Springs, CA; LTV1000, Pulmonetic Systems, Colton,
CA; Esprit, Respironics, Vista, CA) with a standard ICU ventilator
(model 7200ae; Mallinckrodt) using a test lung that simulated
spontaneous breathing (compliance, 46.8 mL/cm H2O;
resistance, 5 cm H2O/L/s). The settings of ventilators were
positive end-expiratory pressure (PEEP) of 0 or 5 cm H2O,
and pressure support (PS) of 0 or 10 cm H2O. The settings
of the test lung were inspiratory time of 1 s, respiratory rate of
10/min, peak inspiratory flow of 40, 60, and 80 L/min. To evaluate
inspiratory function at each setting, we measured the inspiratory delay
time (DT), inspiratory trigger pressure (P-I), and the time for airway
pressure to rise from the baseline pressure to 90% of the
end-inspiratory pressure (T90%); for expiratory function,
supraplateau expiratory pressure (P-E) and the time constant (
e) for
pressure decrease during exhalation were evaluated. Oxygen requirement
was assessed as the time required to empty a 3.5-L oxygen tank.
Results: For inspiratory triggering, four transport
ventilators had DT < 100 ms, which is considered clinically
satisfactory, in all the settings except for PS 0 cm H2O,
PEEP 0 cm H2O, and inspiratory flow of 80 L/min with
LTV1000. P-I increased only in LTV1000 when PEEP was increased from 0
to 5 cm H2O. e for the transport ventilators was
> 50% shorter than for the ICU ventilator except for PS 0 cm
H2O and PEEP 5 cm H2O with TBird. Oxygen
requirement was lowest for the Esprit, followed by the 740, LTV1000,
and TBird.
Conclusion: The newer Food and Drug Administration–approved transport ventilators have performance indexes comparable to the ventilator currently used in ICUs and can probably be recommended for clinical use.
Key Words: ARDS • transport • ventilator performance • work of breathing
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