Abstract
BackgroundIntensive Care Units (ICU) have sometimes been overwhelmed by the surge of COVID-19 patients. Extending ICU capacity can be limited by the lack of air and oxygen pressure sources available. Transport ventilators requiring only one O2 source may be used in such places.ObjectiveTo evaluate the performances of four transport ventilators and an ICU ventilator in simulated severe respiratory conditions.Materials and methodsTwo pneumatic transport ventilators, (Oxylog 3000, Draeger; Osiris 3, Air Liquide Medical Systems), two turbine transport ventilators (Elisee 350, ResMed; Monnal T60, Air Liquide Medical Systems) and an ICU ventilator (Engström Carestation—GE Healthcare) were evaluated on a Michigan test lung. We tested each ventilator with different set volumes (Vtset = 350, 450, 550 ml) and compliances (20 or 50 ml/cmH2O) and a resistance of 15 cmH2O/l/s based on values described in COVID-19 Acute Respiratory Distress Syndrome. Volume error (percentage of Vtset) with P0.1 of 4 cmH2O and trigger delay during assist-control ventilation simulating spontaneous breathing activity with P0.1 of 4 cmH2O and 8 cmH2O were measured.ResultsGrouping all conditions, the volume error was 2.9 ± 2.2% for Engström Carestation; 3.6 ± 3.9% for Osiris 3; 2.5 ± 2.1% for Oxylog 3000; 5.4 ± 2.7% for Monnal T60 and 8.8 ± 4.8% for Elisee 350. Grouping all conditions (P0.1 of 4 cmH2O and 8 cmH2O), trigger delay was 50 ± 11 ms, 71 ± 8 ms, 132 ± 22 ms, 60 ± 12 and 67 ± 6 ms for Engström Carestation, Osiris 3, Oxylog 3000, Monnal T60 and Elisee 350, respectively.ConclusionsIn surge situations such as COVID-19 pandemic, transport ventilators may be used to accurately control delivered volumes in locations, where only oxygen pressure supply is available. Performances regarding triggering function are acceptable for three out of the four transport ventilators tested.
Highlights
During the COVID 19 pandemic, several hospitals experienced the greatest shortage of ventilators ever seen since the heroic times of the polio epidemic in the1950s
We tested each ventila‐ tor with different set volumes (Vtset = 350, 450, 550 ml) and compliances (20 or 50 ml/cmH2O) and a resistance of 15 cmH2O/l/s based on values described in COVID-19 Acute Respiratory Distress Syndrome
Limits of pneumatic ventilators have not been tested with the appropriate settings in realistic conditions simulating the respiratory mechanics of patients with COVID-19 induced Acute Respiratory Distress Syndrome (ARDS) [6,7,8,9]
Summary
During the COVID 19 pandemic, several hospitals experienced the greatest shortage of ventilators ever seen since the heroic times of the polio epidemic in the1950s. They must allow to vary FiO2 without requiring two pressurized sources of gas (i.e., wall air and oxygen at 50 psi). The general view on these ventilators is, that their limitations make them acceptable only for a short period like transport but make them incompatible with the safe delivery of difficult ventilation for very sick patients over prolonged periods They have limited capacities regarding ventilation modes and monitoring, but knowing whether their reliability is sufficient for delivering lung protective ventilation in patients with ARDS merited to be tested with these objectives in mind. Transport ventilators requiring only one O 2 source may be used in such places
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