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Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study

Thomas Drevhammar1, Kjell Nilsson2, Henrik Zetterström3

  • 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm Department of Anaesthesiology, Östersund Hospital, Östersund thomas.drevhammar@regionjh.se.

Respiratory Care
|February 26, 2015
PubMed

Insights

Nasal CPAP pressure stability varied significantly across ventilators when leaks were simulated. Effective neonatal respiratory support requires evaluating both mean pressure delivery and pressure variations during leaks.

Area of Science:

  • Neonatal respiratory support
  • Medical device engineering

Background:

  • Nasal continuous positive airway pressure (CPAP) is a primary respiratory support for neonates.
  • Effective nasal CPAP requires stable pressure delivery and minimal leaks at the patient interface.
  • Assessing pressure stability during leaks involves analyzing mean delivered CPAP and breath-to-breath pressure variations.

Purpose of the Study:

  • To evaluate the performance of ventilators delivering nasal CPAP when subjected to simulated leaks.
  • To determine how ventilator responses to leaks impact pressure stability.

Main Methods:

  • Seven ventilators delivering nasal CPAP at 4 cm H2O were tested.
  • Simulated neonatal breathing with controlled leaks (1-4 L/min) applied for 15 breaths.
  • Measured mean delivered CPAP and pressure swing amplitude before, during, and after leaks.

Main Results:

  • Significant variability was observed in the ability of ventilators to maintain delivered CPAP and pressure swing amplitude during leaks.
  • Four of the seven ventilators incorporated built-in leak compensation mechanisms.
  • Performance in maintaining delivered CPAP did not correlate with the ability to minimize pressure swings.

Conclusions:

  • Maintaining delivered CPAP and minimizing pressure swings are distinct aspects of pressure stability during leaks.
  • Clinical importance of pressure stability in neonatal nasal CPAP requires evaluation of both mean pressure and pressure variations.
  • Leak compensation in ventilators does not inherently guarantee pressure-stable CPAP delivery.
Abstract

Keywords:
continuous positive airway pressureequipment designinfant newbornintensive caremechanicalneonatalventilatorswork of breathing

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