Accuracy of P0.1 measurements performed by ICU ventilators: a bench study
Abstract Background Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automate...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
SpringerOpen
2019-09-01
|
Series: | Annals of Intensive Care |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13613-019-0576-x |
id |
doaj-bb64535ebf404f38a8f8461592e9f133 |
---|---|
record_format |
Article |
spelling |
doaj-bb64535ebf404f38a8f8461592e9f1332020-11-25T01:56:09ZengSpringerOpenAnnals of Intensive Care2110-58202019-09-01911910.1186/s13613-019-0576-xAccuracy of P0.1 measurements performed by ICU ventilators: a bench studyFrançois Beloncle0Lise Piquilloud1Pierre-Yves Olivier2Alice Vuillermoz3Elise Yvin4Alain Mercat5Jean-Christophe Richard6Medical Intensive Care Unit, University Hospital of Angers, UNIV AngersMedical Intensive Care Unit, University Hospital of Angers, UNIV AngersMedical Intensive Care Unit, University Hospital of Angers, UNIV AngersMedical Intensive Care Unit, University Hospital of Angers, UNIV AngersMedical Intensive Care Unit, University Hospital of Angers, UNIV AngersMedical Intensive Care Unit, University Hospital of Angers, UNIV AngersSAMU74, Emergency Department, General Hospital of AnnecyAbstract Background Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators. Methods Five ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1ref). The pressure drop after 100 ms was measured offline on the airway pressure–time curves recorded during the automated P0.1 measurements (P0.1aw). P0.1vent was compared to P0.1ref and to P0.1aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1circuit). Results Variations of P0.1vent correlated well with variations of P0.1ref. Overall, P0.1vent underestimated P0.1ref except for the Löwenstein® ventilator at P0.1ref 2.5 cm H2O and for the Getinge group® ventilator at P0.1ref 10 cm H2O. The agreement between P0.1vent and P0.1ref assessed with the Bland–Altman method gave a mean bias of − 1.3 cm H2O (limits of agreement: 1 and − 3.7 cm H2O). Analysis of airway pressure–time and flow–time curves showed that all the tested ventilators except the Getinge group® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1vent and P0.1aw assessed with the Bland–Altman method gave a mean bias of 0.5 cm H2O (limits of agreement: 2.4 and − 1.4 cm H2O). The circuit’s length impacted P0.1 measurements’ values. A longer circuit was associated with lower P0.1circuit values. Conclusion P0.1vent relative changes are well correlated to P0.1ref changes in all the tested ventilators. Accuracy of absolute values of P0.1vent varies according to the ventilator model. Overall, P0.1vent underestimates P0.1ref. The length of the circuit may partially explain P0.1vent underestimation.http://link.springer.com/article/10.1186/s13613-019-0576-xMechanical ventilationOcclusion pressureRespiratory driveInspiratory effortRespiratory failure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
François Beloncle Lise Piquilloud Pierre-Yves Olivier Alice Vuillermoz Elise Yvin Alain Mercat Jean-Christophe Richard |
spellingShingle |
François Beloncle Lise Piquilloud Pierre-Yves Olivier Alice Vuillermoz Elise Yvin Alain Mercat Jean-Christophe Richard Accuracy of P0.1 measurements performed by ICU ventilators: a bench study Annals of Intensive Care Mechanical ventilation Occlusion pressure Respiratory drive Inspiratory effort Respiratory failure |
author_facet |
François Beloncle Lise Piquilloud Pierre-Yves Olivier Alice Vuillermoz Elise Yvin Alain Mercat Jean-Christophe Richard |
author_sort |
François Beloncle |
title |
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study |
title_short |
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study |
title_full |
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study |
title_fullStr |
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study |
title_full_unstemmed |
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study |
title_sort |
accuracy of p0.1 measurements performed by icu ventilators: a bench study |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2019-09-01 |
description |
Abstract Background Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators. Methods Five ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1ref). The pressure drop after 100 ms was measured offline on the airway pressure–time curves recorded during the automated P0.1 measurements (P0.1aw). P0.1vent was compared to P0.1ref and to P0.1aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1circuit). Results Variations of P0.1vent correlated well with variations of P0.1ref. Overall, P0.1vent underestimated P0.1ref except for the Löwenstein® ventilator at P0.1ref 2.5 cm H2O and for the Getinge group® ventilator at P0.1ref 10 cm H2O. The agreement between P0.1vent and P0.1ref assessed with the Bland–Altman method gave a mean bias of − 1.3 cm H2O (limits of agreement: 1 and − 3.7 cm H2O). Analysis of airway pressure–time and flow–time curves showed that all the tested ventilators except the Getinge group® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1vent and P0.1aw assessed with the Bland–Altman method gave a mean bias of 0.5 cm H2O (limits of agreement: 2.4 and − 1.4 cm H2O). The circuit’s length impacted P0.1 measurements’ values. A longer circuit was associated with lower P0.1circuit values. Conclusion P0.1vent relative changes are well correlated to P0.1ref changes in all the tested ventilators. Accuracy of absolute values of P0.1vent varies according to the ventilator model. Overall, P0.1vent underestimates P0.1ref. The length of the circuit may partially explain P0.1vent underestimation. |
topic |
Mechanical ventilation Occlusion pressure Respiratory drive Inspiratory effort Respiratory failure |
url |
http://link.springer.com/article/10.1186/s13613-019-0576-x |
work_keys_str_mv |
AT francoisbeloncle accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT lisepiquilloud accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT pierreyvesolivier accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT alicevuillermoz accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT eliseyvin accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT alainmercat accuracyofp01measurementsperformedbyicuventilatorsabenchstudy AT jeanchristopherichard accuracyofp01measurementsperformedbyicuventilatorsabenchstudy |
_version_ |
1724981099454529536 |