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Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

¹ Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, and ² Alizé de Bourgogne, Dijon, France.

CORRESPONDENCE: C. Rabec, Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, 2 Bd Maréchal de Lattre de Tassigny, 21079 Dijon, France. E-mail: claudio.rabec{at}chu-dijon.fr

Keywords: Bench testing, bi-level positive airway pressure, clinical evaluation, monitoring, noninvasive ventilation, respiratory failure

Received: November 10, 2008
Accepted March 16, 2009

Empirically determined noninvasive ventilation (NIV) settings may not achieve optimal ventilatory support. Some ventilators include monitoring modules to assess ventilatory quality. We conducted a bench-to-bedside study to assess the ventilatory quality of the VPAP^TMIII-ResLink^TM (ResMed, North Ryde, Australia).

We tested the accuracy of minute ventilation (MV) and leak calculations given by VPAP^TMIII-ResLink^TM compared to those measured by a bench model at varied leak levels and ventilator settings. We systematically assessed NIV efficacy using this system from 2003 to 2006. Ventilation was considered inadequate if leak (>24 L·min^–1), continuous desaturation (>30% of the trace) or desaturation dips (>3%) were present.

On the bench test, both methods were highly correlated (r = 0.947, p>0.0001 and r = 0.959, p<0.0001 for leak and MV, respectively). We performed 222 assessments in 169 patients (aged 66.42±16 yrs, 100 males). Abnormalities were detected on 147 (66%) out of 222 occasions. Leak was the most common abnormality (34.2%) followed by desaturation dips (23.8%). The most effective therapeutic solutions were a chin strap if leak was detected (61.2%) and expiratory positive airway pressure increase for desaturation dips (59.5%). In 15.7% of cases, when abnormalities persisted, a polygraphy was performed.

The systematic use of this device enables NIV to be optimised, limiting the indication of sleep studies to complex cases.