Respiratory Muscle Performance, Pulmonary Mechanics, and Gas Exchange Between the BiPAP S/T-D System and the Servo Ventilator 900C With Bilevel Positive Airway Pressure Ventilation Following Gradual Pressure Support Weaning

Abstract

Our objective was to compare respiratory muscle performance, pulmonary mechanics, and gas exchange between the BiPAP S/T-D ventilation system (Respironics Inc; Murrysville, PA) and the Servo Ventilator 900C (Siemens-Elma AB; Sweden) with similar inspiratory and expiratory airway pressure in patients who are recovering from acute respiratory failure. A prospective, randomized, clinical trial. Medical ICU. We studied 27 medical patients on mechanical ventilators following gradual pressure support weaning. Each patient breathed while in the following equivalent modes: (a) an inspiratory pressure preset (pressure support mode) of 5 cm H2O with an external positive end-expiratory pressure (PEEP) of 5 cm H2O on the Servo Ventilator 900C and (b) an inspiratory pressure preset of 10 cm H2O with an expiratory pressure preset of 5 cm H2O on the BiPAP S/T-D. Using the CP-100 pulmonary monitor, we compared the total work of breathing (WOB), the pressure-time index (PTP), and other pulmonary mechanics and gas exchange parameters between the two modes. The WOB injoules per liter (mean +/- SE) (0.76+/-0.08 vs 0.73+/-0.08, p = 0.70), the WOB in joules per minute (8.62+/-1.06 vs 8.11+/-0.96, p = 0.60), and the PTP in cm H2O/s/min (187+/-18 vs 167+/-18, p = 0.21) between the BiPAP S/T-D and the Servo Ventilator 900C were not statistically different. There were statistically significant differences between the two ventilators in auto-PEEP (1.34+/-0.37 vs 0.88+/-0.30 cm H2O, p = 0.03), duty cycle (0.44+/-0.01 vs 0.37+/-0.01, p < 0.001), and expiratory airway resistance (11.81+/-1.53 vs 8.75+/-1.22 cm H2O/L/s, p < 0.001), but not in respiratory rate (27.48+/-1.54 vs 28.06+/-1.61 breaths/min, p = 0.40) or in minute ventilation (10.43+/-0.59 vs 10.27+/-0.37 L/min, p = 0.66). There was a statistically significant difference in the ratio of Pa(O2) to the fraction of inspired oxygen (F(IO2)) (333+/-21 vs 300+/-22, p < 0.03) but not in Pa(CO2) (48+/-2 vs 47+/-2 mm Hg, p = 0.59) between the BiPAP S/T-D and the Servo Ventilator 900C. Despite differences in initiating and maintaining the inspiratory and expiratory phases, in breathing circuits, and in ventilator circuits between the two ventilators, the performance of the BiPAP S/T-D is equally efficacious to that of a conventional mechanical ventilator in supporting respiratory muscles. Thus, the BiPAP S/T-D is safe and effective when used in mechanically ventilated patients recovering from acute respiratory failure who do not require total ventilatory support.