F Lofaso, L Brochard, T Hang, H Lorino, A Harf and D Isabey
Institut National de la Sante et de la Recherche Medicale INSERM U 296, Services de Physiologie-Explorations Fonctionnelles et de Reanimation Medicale, Hopital Henri Mondor, Creteil, France.

A bench study using an artificial lung model and a clinical study in patients were performed to evaluate six commercially available home pressure support devices. Six devices were tested in the in vitro study, including five designed for home use and one designed for use in intensive care units. Minimal positive end-expiratory pressure (PEEP) varied across home devices, from 0.5 cm H2O to 4.3 cm H2O. Work imposed during exhalation varied up to six-fold across devices. A substantial rebreathing volume has present for the three home devices with a common inspiratory and expiratory line. This rebreathing volume decreased with increasing PEEP level, as expected, but remained substantial at the widely used PEEP level of 5 cm H2O. Use of a non-rebreathing valve increased both the work imposed by the circuit during the exhalation phase and the time required to attain the relaxation equilibrium. Except for two home devices and a bilevel positive airway pressure (BiPAP) device equipped with a non-rebreathing valve, differences in inspiratory trigger sensitivities were small between home and intensive care devices. During pressure support, the total work performed by the machines did not differ by more than 15% between devices, whereas differences of more than 300% were observed in flow acceleration. Only one home device gave a flow acceleration similar to or better than that obtained with the intensive care device. In a randomized, crossover clinical study, we compared a home device to a device specially designed for intensive care use in seven intubated patients during weaning from mechanical ventilation. The main differences between the two devices were trigger sensitivity and initial flow acceleration. For the same level of pressure support, there were no significant differences in arterial PCO2, tidal volume, respiratory rate, or minute ventilation between these two devices. However, the esophageal pressure- time product was 30% higher with the home device (165 +/- 93 versus 119 +/- 80 cm H2O/min, p < 0.05). In conclusion, differences exist between devices in terms of occurrence of rebreathing, speed of attainment of stable pressure support level, and expiratory resistance. These differences characterizing the delivery of pressure support may have clinical impact on the inspiratory effort of patients.

This article has been cited by other articles:

				J. Gonzalez-Bermejo, V. Laplanche, F. E. Husseini, A. Duguet, J-P. Derenne, and T. Similowski Evaluation of the user-friendliness of 11 home mechanical ventilators Eur. Respir. J., June 1, 2006; 27(6): 1236 - 1243. [Abstract] [Full Text] [PDF]

				E. Miyoshi, Y. Fujino, A. Uchiyama, T. Mashimo, and M. Nishimura Effects of Gas Leak on Triggering Function, Humidification, and Inspiratory Oxygen Fraction During Noninvasive Positive Airway Pressure Ventilation Chest, November 1, 2005; 128(5): 3691 - 3698. [Abstract] [Full Text] [PDF]

				R Agarwal, A N Aggarwal, D Gupta, and S K Jindal Non-invasive ventilation in acute cardiogenic pulmonary oedema Postgrad. Med. J., October 1, 2005; 81(960): 637 - 643. [Abstract] [Full Text] [PDF]

				A. Battisti, D. Tassaux, J.-P. Janssens, J.-B. Michotte, S. Jaber, and P. Jolliet Performance Characteristics of 10 Home Mechanical Ventilators in Pressure-Support Mode: A Comparative Bench Study Chest, May 1, 2005; 127(5): 1784 - 1792. [Abstract] [Full Text] [PDF]

				B. Fauroux, F. Nicot, S. Essouri, N. Hart, A. Clement, M.I. Polkey, and F. Lofaso Setting of noninvasive pressure support in young patients with cystic fibrosis Eur. Respir. J., October 1, 2004; 24(4): 624 - 630. [Abstract] [Full Text] [PDF]

				M.W. Elliott The interface: crucial for successful noninvasive ventilation Eur. Respir. J., January 1, 2004; 23(1): 7 - 8. [Full Text] [PDF]

				T. Sharshar, G. Desmarais, B. Louis, G. Macadou, R. Porcher, A. Harf, J.-C. Raphael, D. Isabey, and F. Lofaso Transdiaphragmatic Pressure Control of Airway Pressure Support in Healthy Subjects Am. J. Respir. Crit. Care Med., October 1, 2003; 168(7): 760 - 769. [Abstract] [Full Text] [PDF]

				T. Liesching, H. Kwok, and N. S. Hill Acute Applications of Noninvasive Positive Pressure Ventilation Chest, August 1, 2003; 124(2): 699 - 713. [Abstract] [Full Text] [PDF]

				M.P. Highcock, J.M. Shneerson, and I.E. Smith Increased ventilation with NiIPPV does not necessarily improve exercise capacity in COPD Eur. Respir. J., July 1, 2003; 22(1): 100 - 105. [Abstract] [Full Text] [PDF]

				M. Vitacca, L. Barbano, S. D'Anna, R. Porta, L. Bianchi, and N. Ambrosino Comparison of Five Bilevel Pressure Ventilators in Patients With Chronic Ventilatory Failure: A Physiologic Study Chest, December 1, 2002; 122(6): 2105 - 2114. [Abstract] [Full Text] [PDF]

				M.P. Highcock, E. Morrish, S. Jamieson, J.M. Shneerson, and I.E. Smith An overnight comparison of two ventilators used in the treatment of chronic respiratory failure Eur. Respir. J., October 1, 2002; 20(4): 942 - 945. [Abstract] [Full Text] [PDF]

				B. Schonhofer and S. Sortor-Leger Equipment needs for noninvasive mechanical ventilation Eur. Respir. J., October 1, 2002; 20(4): 1029 - 1036. [Abstract] [Full Text] [PDF]

				J. E. Johnson, D. J. Gavin, and S. Adams-Dramiga Effects of Training With Heliox and Noninvasive Positive Pressure Ventilation on Exercise Ability in Patients With Severe COPD* Chest, August 1, 2002; 122(2): 464 - 472. [Abstract] [Full Text] [PDF]

				N. S. Hill, C. Carlisle, and N. R. Kramer Effect of a Nonrebreathing Exhalation Valve on Long-term Nasal Ventilation Using a Bilevel Device* Chest, July 1, 2002; 122(1): 84 - 91. [Abstract] [Full Text] [PDF]

				M. P. Highcock, I. E. Smith, and J. M. Shneerson The Effect of Noninvasive Intermittent Positive-Pressure Ventilation During Exercise in Severe Scoliosis* Chest, May 1, 2002; 121(5): 1555 - 1560. [Abstract] [Full Text] [PDF]

				Non-invasive ventilation in acute respiratory failure Thorax, March 1, 2002; 57(3): 192 - 211. [Full Text] [PDF]

				I. M. STELL, G. PAUL, K. C. LEE, J. PONTE, and J. MOXHAM Noninvasive Ventilator Triggering in Chronic Obstructive Pulmonary Disease . A Test Lung Comparison Am. J. Respir. Crit. Care Med., December 1, 2001; 164(11): 2092 - 2097. [Abstract] [Full Text] [PDF]

				M. Wysocki and M. Antonelli Noninvasive mechanical ventilation in acute hypoxaemic respiratory failure Eur. Respir. J., July 1, 2001; 18(1): 209 - 220. [Abstract] [Full Text] [PDF]

				M.P. Highcock, J.M. Shneerson, and I.E. Smith Functional differences in bi-level pressure preset ventilators Eur. Respir. J., February 1, 2001; 17(2): 268 - 273. [Abstract] [Full Text] [PDF]

				S. MEHTA and N. S. HILL Noninvasive Ventilation Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 540 - 577. [Full Text]

				B. FAUROUX, E. ITTI, J. PIGEOT, D. ISABEY, M. MEIGNAN, G. FERRY, F. LOFASO, J.-M. WILLEMOT, A. CLÉMENT, and A. HARF Optimization of Aerosol Deposition by Pressure Support in Children with Cystic Fibrosis . An Experimental and Clinical Study Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2265 - 2271. [Abstract] [Full Text]

				M. Vitacca, S. Nava, M. Confalonieri, L. Bianchi, R. Porta, E. Clini, and N. Ambrosino The Appropriate Setting of Noninvasive Pressure Support Ventilation in Stable COPD Patients Chest, November 1, 2000; 118(5): 1286 - 1293. [Abstract] [Full Text] [PDF]

				E. Miyoshi, Y. Fujino, T. Mashimo, and M. Nishimura Performance of Transport Ventilator With Patient-Triggered Ventilation Chest, October 1, 2000; 118(4): 1109 - 1115. [Abstract] [Full Text] [PDF]

				J.-L. Diehl, D. Isabey, G. Desmarais, L. Brochard, A. Harf, and F. Lofaso Physiological effects of alveolar, tracheal, and "standard" pressure supports J Appl Physiol, July 1, 1999; 87(1): 428 - 437. [Abstract] [Full Text] [PDF]

				B. Fauroux, D. Isabey, G. Desmarais, L. Brochard, A. Harf, and F. Lofaso Nonchemical influence of inspiratory pressure support on inspiratory activity in humans J Appl Physiol, December 1, 1998; 85(6): 2169 - 2175. [Abstract] [Full Text] [PDF]

				S. Nava, M. Confalonieri, and C. Rampulla Intermediate respiratory intensive care units in Europe: a European perspective Thorax, September 1, 1998; 53(9): 798 - 802. [Full Text]

				R. E. Hillberg and D. C. Johnson Noninvasive Ventilation N. Engl. J. Med., December 11, 1997; 337(24): 1746 - 1752. [Full Text] [PDF]

				P. ASLANIAN, S. E. ATROUS, D. ISABEY, E. VALENTE, D. CORSI, A. HARF, F. LEMAIRE, and L. BROCHARD Effects of Flow Triggering on Breathing Effort During Partial Ventilatory Support Am. J. Respir. Crit. Care Med., January 1, 1997; 157(1): 135 - 143. [Abstract] [Full Text]