Introduction
Materials and methods
Equipment and setup
NIV interface
Modes of ventilation and ventilator tested
Lung model
Study protocol
Ventilatory settings
Lung model setting
Measurements
Respiratory mechanics
Carbon dioxide measurements
Noise exposure
Data analysis
Statistical analysis
Results
Airway pressures and pressure time products
Normal lung condition | |||||||||
---|---|---|---|---|---|---|---|---|---|
Respiratory rate | 15 breaths/minute | 30 breaths/minute | |||||||
Δ pressure | 5 cmH20 | 15 cmH20 | 5 cmH20 | 15 cmH20 | |||||
Effort | low | high | low | high | low | high | low | high | |
Paw mean (cmH2O) | HF-BiPAP | 10.2 ± 0.3 | 10.4 ± 0.4 | 15.2 ± 0.4 | 14.7 ± 0.3 | 10.7 ± 0.2 | 11.1 ± 0.5 | 15.1 ± 0.5 | 15.0 ± 0.2 |
BiVent | 10.1 ± 0.1 | 9.8 ± 0.1 | 14.8 ± 0.3 | 14.5 ± 0.1 | 10.6 ± 0.2 | 9.8 ± 0.2 | 15.0 ± 0.3 | 15.2 ± 0.3 | |
PSV | 8.7 ± 0.2 | 8.4 ± 0.2 | 11.9 ± 0.6 | 11.6 ± 0.7 | 9.6 ± 0.4 | 8.7 ± 0.2 | 12 ± 0.4 | 13.2 ± 0.9 | |
PTPexp. (cmH20/sec) | HF-BiPAP | 4.3 ± 1.1 | 10.6 ± 3.2 | 13.9 ± 1.1 | 21.4 ± 1.7 | 3.1 ± 0.4 | 7.4 ± 1.4 | 2.7 ± 0.7 | 9.2 ± 1.2 |
BiVent | 4.6 ± 0.5 | 5.7 ± 0.3 | 18.7 ± 0.7 | 21.7 ± 0.8 | 2.8 ± 0.2 | 2.9 ± 0.8 | 9.8 ± 0.6 | 9.4 ± 0.8 | |
PSV | 1.9 ± 0.5 | 3.2 ± 0.7 | 6.7 ± 0.4 | 7 ± 0.6 | 1.9 ± 0.9 | 2.5 ± 0.3 | 4.4 ± 4.9 | 2.2 ± 0.7 | |
CO
2
max (%) | HF-BiPAP | 0.1 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.2 ± 0 | 0.2 ± 0 |
BiVent | 4.2 ± 0 | 4.0 ± 0.1 | 2.1 ± 0 | 3.2 ± 0 | 3.9 ± 0.1 | 2.6 ± 0 | 1.9 ± 0 | 1.4 ± 0.2 | |
PSV | 0.2 ± 0 | 1.2 ± 0 | 1 ± 0 | 0.8 ± 0 | 0.9 ± 0 | 0.7 ± 0 | 1 ± 0.2 | 0.5 ± 0 | |
Obstructive lung condition
| |||||||||
Respiratory rate
| 15 breaths/minute | 30 breaths/minute | |||||||
Δ pressure
| 5 cmH20 | 15 cmH20 | 5 cmH20 | 15 cmH20 | |||||
Effort
| low | high | low | high | low | high | low | high | |
Paw mean (cmH2O) | HF-BiPAP | 10.4 ± 0.1 | 9.9 ± 0.1 | 14.1 ± 0.1 | 14 ± 0.1 | 10.2 ± 0.1 | 10.7 ± 0 | 14.6 ± 0.1 | 15.6 ± 0.2 |
BiVent | 9.9 ± 0.2 | 10.1 ± 0.1 | 15.5 ± 0.1 | 14.9 ± 0 | 9.9 ± 0.1 | 10.3 ± 0 | 15.3 ± 0.2 | 15.8 ± 0.2 | |
PSV | 9.3 ± 0.1 | 9.1 ± 0 | 11.6 ± 0.1 | 10.6 ± 0.1 | 9.1 ± 0.1 | 9.3 ± 0.1 | 11.2 ± 0.5 | 12.3 ± 0.1 | |
PTPexp. (cmH20/sec) | HF-BiPAP | 9 ± 0.5 | 3.4 ± 0.6 | 15.9 ± 1.1 | 19.4 ± 0.9 | 7.7 ± 0.9 | 5.7 ± 0.8 | 11.1 ± 2.3 | 16.9 ± 3.5 |
BiVent | 6 ± 0.5 | 7.4 ± 0.6 | 18.5 ± 0.7 | 19.5 ± 0.3 | 5.9 ± 0.4 | 6.1 ± 0.1 | 9.4 ± 0.3 | 8 ± 0.4 | |
PSV | 3.7 ± 0.7 | 2.4 ± 0.3 | 3.2 ± 0.9 | 2.2 ± 0.3 | 3.8 ± 0.4 | 5.5 ± 0.3 | 2.5 ± 2 | 4 ± 0.3 | |
CO
2
max (%) | HF-BiPAP | 0.1 ± 0 | 0.1 ± 0 | 0.2 ± 0 | 0.2 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.2 ± 0 | 0.2 ± 0 |
BiVent | 2.5 ± 0 | 3 ± 0.1 | 2.8 ± 0 | 3.2 ± 0 | 4.8 ± 0 | 4.8 ± 0 | 2.3 ± 0 | 2.2 ± 0 | |
PSV | 0.2 ± 0 | 0.9 ± 0 | 0.1 ± 0 | 0.6 ± 0 | 0.4 ± 0 | 0.4 ± 0 | 0.1 ± 0 | 0.2 ± 0 | |
Restrictive lung condition
| |||||||||
Respiratory rate
| 15 breaths/minute | 30 breaths/minute | |||||||
Δ pressure
| 5 cmH20 | 15 cmH20 | 5 cmH20 | 15 cmH20 | |||||
Effort
| low | high | low | high | Low | high | low | high | |
Paw mean (cmH2O) | HF-BiPAP | 9.9 ± 0.3 | 10.7 ± 0.3 | 14.6 ± 0.2 | 14.3 ± 0.3 | 10.1 ± 0.2 | 11.5 ± 0.3 | 14.4 ± 0.1 | 14.9 ± 0.1 |
BiVent | 9.9 ± 0.2 | 9.9 ± 0.1 | 14.9 ± 0.1 | 14.9 ± 0.2 | 10.0 ± 0.3 | 9.8 ± 0.1 | 16.3 ± 0.2 | 16.3 ± 0.2 | |
PSV | 11.6 ± 0.6 | 9.3 ± 0.1 | 10.1 ± 0.1 | 9.8 ± 0.1 | 10.2 ± 0.3 | 9.1 ± 0 | 15.9 ± 0.4 | 11.3 ± 0.1 | |
PTP exp. (cmH20/sec) | HF-BiPAP | 6.4 ± 2.9 | 10.1 ± 3 | 13.8 ± 1.5 | 15.0 ± 9.6 | 3.3 ± 1 | 4.8 ± 1.1 | 9.5 ± 2.4 | 11.7 ± 1.3 |
BiVent | 5.4 ± 1.7 | 6.6 ± 1 | 9.0 ± 0.6 | 12.1 ± 0.6 | 3.0 ± 0.3 | 2.5 ± 0.3 | 6.6 ± 0.5 | 8.9 ± 0.7 | |
PSV | 5.2 ± 0.5 | 4.5 ± 0.7 | 3.1 ± 0.4 | 3.3 ± 0.4 | 3.0 ± 0.8 | 2.5 ± 0.3 | 5.6 ± 0.8 | 4.9 ± 0.6 | |
CO
2
max (%) | HF-BiPAP | 0.1 ± 0 | 0.1 ± 0 | 0.2 ± 0 | 0.2 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.1 ± 0 | 0.3 ± 0 |
BiVent | 4.7 ± 0 | 4.7 ± 0.1 | 4.2 ± 0 | 4.4 ± 0.1 | 4.1 ± 0 | 3.0 ± 0.1 | 3.8 ± 0 | 2.9 ± 0 | |
PSV | 0.4 ± 0 | 0.8 ± 0 | 0.3 ± 0 | 0.4 ± 0 | 0.4 ± 0 | 0.7 ± 0 | 1.0 ± 0.1 | 0.6 ± 0 |
Δ pressure | 5 cmH20 | 15 cmH20 | ||||
---|---|---|---|---|---|---|
Effort | low | high | low | high | ||
Normal lung condition
| Paw mean (cmH2O) |
HF-BiPAP nBBIPAPBiPulse
| 10.5 ± 0.9 | 12.1 ± 0.2 | 14.6 ± 2.9 | 15.6 ± 2.4 |
BiVent
| 10.6 ± 1.2 | 11.8 ± 1.8 | 15.3 ± 2.8 | 15.5 ± 2.2 | ||
PTP
PEEP
. (cmH20/sec) |
HF-BiPAP
| -0.1 ± 0.1 | -0.2 ± 0.2 | -0.2 ± 0.1 | -0.1 ± 0.1 | |
BiVent
| 0 ± 0 | -0.2 ± 0.1 | 0 ± 0 | -0.3 ± 0.2 | ||
PTP insp. (cmH20/sec) |
HF-BiPAP
| 1.2 ± 0.8 | 1.1 ± 0.7 | 3.3 ± 2.6 | 4 ± 1.7 | |
BiVent
| 1.3 ± 1.2 | 1.8 ± 1.5 | 2.7 ± 1.7 | 3.5 ± 2.4 | ||
PTP exp. (cmH20/sec) |
HF-BiPAP e
| 7 ± 6.1 | 3.8 ± 1.8 | 10 ± 6.4 | 4.2 ± 1.8 | |
BiVent
| 7.2 ± 3.2 | 7.0 ± 0.9 | 11.8 ± 3.9 | 4.6 ± 1.8 | ||
Obstructive lung condition
| Paw mean (cmH2O) |
HF-BiPAP
| 10.4 ± 1 | 10.4 ± 0.7 | 15 ± 3.8 | 16.3 ± 3.4 |
BiVent
| 10.3 ± 2.3 | 11 ± 3.5 | 15.4 ± 7.2 | 15.4 ± 4.1 | ||
PTP
PEEP
. (cmH20/sec) |
HF-BiPAP
| 0 ± 0 | -0.13 ± 0.15 | -0.01 ± 0.05 | -0.05 ± 0.16 | |
BiVent
| 0 ± 0 | -0.2 ± 0.01 | -0.02 ± 0.04 | -0.2 ± 0.24 | ||
PTP insp. (cmH20/sec) |
HF-BiPAP
| 1.0 ± 0.9 | 2.04 ± 1.4 | 3.6 ± 2.6 | 3.6 ± 2 | |
BiVent
| 1.3 ± 1.1 | 2.5 ± 2.4 | 2.8 ± 2.1 | 3.1 ± 2.7 | ||
PTP exp. (cmH20/sec) |
HF-BiPAP
| 3.8 ± 2.5 | 9.8 ± 4.8 | 2.9 ± 1.7 | 10.1 ± 8.1 | |
BiVent
| 7.2 ± 3.2 | 10.9 ± 4.1 | 3.8 ± 1.9 | 10.3 ± 3.8 | ||
Restrictive lung condition
| Paw mean (cmH2O) |
HF-BiPAP
| 10.5 ± 1 | 11.7 ± 0.1 | 14.7 ± 2.2 | 14.7 ± 2.3 |
BiVent
| 9.9 ± 1 | 11.1 ± 1 | 15 ± 2.8 | 15.4 ± 4.7 | ||
PTP
PEEP
. (cmH20/sec) |
HF-BiPAP
| -0.16 ± 0.2 | -0.1 ± 0.2 | 0.09 ± 0.1 | -0.09 ± 0.1 | |
BiVent
| -0.35 ± 0.4 | -0.24 ± 0.2 | -0.16 ± 0.2 | -0.16 ± 0.2 | ||
PTP insp. (cmH20/sec) |
HF-BiPAP
| 1 ± 0.6 | 1.2 ± 0.2 | 3.3 ± 2 | 3.4 ± 2 | |
BiVent
| 2 ± 1.5 | 1.4 ± 0.9 | 3.3 ± 2.9 | 1.9 ± 2.4 | ||
PTP exp. (cmH20/sec) |
HF-BiPAP
| 3.7 ± 1.7 | 7.8 ± 3.7 | 4.2 ± 2.4 | 9.4 ± 4.5 | |
BiVent
| 5 ± 1 | 7.2 ± 4.9 | 7.5 ± 3.2 | 10.1 ± 5.5 |
Helmet and lung simulator ventilation
Carbon dioxide removal
Noise exposure
Discussion
Conclusions
Key messages
-
HF-BiPAP provides adequate pressurization at low levels of assistance. It is effective in both restrictive and obstructive lung conditions, even when there is high inspiratory effort.
-
HF-BiPAP compensates a pressure drop below the lower pressure level during inspiration more efficiently than time-cycled pressure control or PSV.
-
HF-BiPAP delivers tidal volumes that are comparable with BiVent or PSV. These volumes are even more efficient at low levels of assistance and higher respiratory rates.
-
HF-BiPAP ensures an efficient CO2 washout, regardless on the effort and clinical condition.