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Demand and continuous flow intermittent mandatory ventilation systems.

K L Christopher, T A Neff, J L Bowman

    Chest
    |May 1, 1985
    PubMed
    Summary
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    Demand and continuous flow intermittent mandatory ventilation (IMV) systems vary significantly in pressure and flow. High inspiratory and expiratory resistance in IMV systems may hinder patient recovery and weaning success.

    Area of Science:

    • Mechanical ventilation
    • Respiratory mechanics
    • Pulmonary rehabilitation

    Background:

    • Intermittent mandatory ventilation (IMV) is used to support patients with respiratory failure.
    • Understanding the performance of different IMV systems is crucial for optimizing patient care and weaning.
    • Demand and continuous flow IMV systems have distinct operational characteristics.

    Purpose of the Study:

    • To evaluate the pressure and flow characteristics of demand and continuous flow IMV systems.
    • To compare the inspiratory pressure required to initiate flow in demand versus assist modes.
    • To assess the expiratory resistance of commercially available exhalation valves.

    Main Methods:

    • A mechanical lung model was employed for system evaluation.

    Related Experiment Videos

  • Negative pressure to initiate inspiratory flow was measured.
  • Peak expiratory resistance was quantified for IMV systems and exhalation valves.
  • The proximal negative inspiratory force (NIF) test methodology was applied.

    • Main Results:

    • Ventilator manometers significantly underestimated the negative pressure needed to open demand valves (p < 0.01).
    • Substantial differences in flow and pressure characteristics were observed between demand and continuous flow IMV systems.
    • High inspiratory and expiratory loads were identified in certain systems.

    Conclusions:

    • Significant performance variations exist among IMV systems, impacting breathing mechanics.
    • Systems with high inspiratory and expiratory loads may impede weaning and patient recovery.
    • The NIF test offers a simple, adaptable method for assessing ventilator performance across institutions.