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Performance of ventilators for noninvasive positive-pressure ventilation in children

¹ Paediatric Pulmonary Dept, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, ² INSERM Mixed Research Unit S-719, Université Pierre et Marie Curie, ³ ADEP Assistance, Puteaux, Paris, ⁴ INSERM Unit 841, ⁵ Paris XII University, Créteil, and ⁶ Dept of Clinical Physiology, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, University of Versailles Saint-Quentin-en-Yvelines, Garches, France.

CORRESPONDENCE: B. Fauroux, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Paediatric Pulmonary Dept, Research Unit INSERM UMR S-719, Université Pierre et Marie Curie Paris 6, 28 avenue du Docteur Arnold Netter, Paris, F-75012, France. Fax: 33 144736174. E-mail: brigitte.fauroux{at}trs.aphp.fr

Keywords: Bench study, child, lung model, pressure support, trigger, volume-targeted ventilation

Received: November 2, 2007
Accepted February 7, 2008

The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France.

The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles.

The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient’s inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients.

A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.

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