紀要論文 Simulation of Spontaneous Breathing Synchronization under Non-Invasive Positive Pressure Ventilation with a Helmet-Type Interface: Comparison of Two Ventilators under Three Different Lung Conditions
ヘルメットタイプのインターフェースを使用したNPPVにおける自発呼吸回調性の検討
Simulation of Spontaneous Breathing Synchronization under Non-Invasive Positive Pressure Ventilation with a Helmet-Type Interface: Comparison of Two Ventilators under Three Different Lung Conditions

小林, 忠宏  ,  中根, 正樹  ,  栗原, 一貴  ,  百瀬, 望  ,  岡田, 真行  ,  小田, 真也  ,  川前, 金幸

内容記述
Purposes: Few studies have investigated the synchronization of different ventilators with spontaneous breathing under non-invasive positive pressure ventilation (NPPV) delivered by helmet interface to the diseased lung. The aim of this study is to investigate ventilator synchronization under pathological conditions by testing the difference of trigger sensitivity between an ordinary ICU ventilator and an NPPV ventilator which are used in our intensive care unit.Methods: A simulator was used to set three lung conditions: (1) normal: compliance (C) of 50 mL/cmH2O and airway resistance (R) of 5 cmH2O/L/sec; (2) obstructive: C50, R20; and (3) restrictive: C20, R5, respectively. To test trigger sensitivity, pressure support ventilation (PSV) mode and spontaneous/time (S/T) mode were selected for the ordinary and NPPV ventilators. We tested multiple positive end expiratory pressure (PEEP; 5, 10, 15 cmH2O) and pressure support (PS; 5, 10, 15 cmH2O) settings, and recorded the inspiratory and expiratory trigger delays under each lung condition.Results: With an ordinary ICU ventilator, neither inspiratory nor expiratory trigger delays were significantly affected by PEEP or PS under any lung conditions. In contrast, with an NPPV ventilator, auto-triggers were frequently recorded for some combinations of PS and lung conditions at 5 cmH2O of PEEP; inspiratory trigger delays worsened at peak inspiratory pressures ≥ 25 cmH2O, and under obstructive conditions, expiratory trigger delays were prolonged in accordance with increasing PS.Conclusions: An ordinary ICU ventilator is superior to an NPPV ventilator in achieving synchronization with spontaneous breathing, especially under obstructive condition and with combination of low PEEP and high PS. We consider that an ordinary ventilator is better choice for such situation than an NPPV ventilator.
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