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(Chest. 2005;128:3691-3698.)
© 2005 American College of Chest Physicians

Effects of Gas Leak on Triggering Function, Humidification, and Inspiratory Oxygen Fraction During Noninvasive Positive Airway Pressure Ventilation*

Eriko Miyoshi, MD; Yuji Fujino, MD; Akinori Uchiyama, MD; Takashi Mashimo, MD and Masaji Nishimura, MD

* From the Intensive Care Unit (Drs. Miyoshi, Fujino, Uchiyama, and Mashimo), Osaka University Hospital, Osaka; and Emergency and Critical Care Medicine (Dr. Nishimura), The University of Tokushima Graduate School, Tokushima, Japan.

Correspondence to: Eriko Miyoshi, MD, Respiratory Care Services, Massachusetts General Hospital, 55 Fruit Street, Ellison 401, Boston, MA 02114; e-mail: miyoshi{at}hp-icu.med.osaka-u.ac.jp

Objectives: During noninvasive positive pressure ventilation (NPPV), the gas leak that commonly occurs around the mask can render NPPV ineffective. We evaluated the effects of gas leak on inspiratory trigger function during NPPV with bilevel pressure and ICU ventilators. In addition, we evaluated the effects of gas leak on fraction of inspired oxygen (FIO2) and humidification.

Methods: Air leak was created at the airway opening of a model lung by establishing several different-size holes in the circuit. During simulated spontaneous breathing, we evaluated inspiratory trigger performance of two bilevel pressure ventilators (BiPAP Vision and BiPAP S/T-D; Respironics; Murrysville, PA) and two ICU ventilators (Puritan-Bennett 7200ae and Puritan-Bennett 840; Tyco Healthcare; Mansfield, MA). Inspiratory delay time and inspiratory trigger pressure were analyzed. FIO2 at the airway opening and inside the model lung were evaluated during BiPAP S/T-D ventilation at supplemental oxygen flows of 3, 6, 9, 12 and 15 L/min. Measured oxygen concentration was compared to mathematically predicted levels. Finally, using two heated humidifiers, we evaluated the effect of gas leak on humidification.

Results: The bilevel pressure ventilators triggered properly at all levels of gas leak, and inspiratory triggering was more effective than with the ICU ventilators. Delivered FIO2 with the BiPAP S/T-D ventilator was affected by gas leak and could be predicted mathematically unless the gas leak was large. With large gas leaks, although relative humidity was maintained, absolute humidity decreased.

Conclusion: Gas leak affected triggering of ICU ventilators, FIO2 of the BiPAP S/T-D ventilator, and humidity with both types of humidifiers.

Key Words: gas leak • humidification • inspiratory fraction of oxygen • noninvasive positive pressure ventilation • triggering function






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