Abstract
Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.
Highlights
Ventilator in the intensive care units (ICU) is life-support device that helps physicians gaining additional time to cure the patients
The analytic hierarchy process (AHP) hierarchy consisted of five criteria regarding the ventilator performance, which were selected based on our experiences and previous studies [2,3,4]
We demonstrated the process of establishing a scoring system to evaluate the overall performance of ventilators
Summary
Ventilator in the intensive care units (ICU) is life-support device that helps physicians gaining additional time to cure the patients. Several previous studies have compared the performance of different ventilators regarding triggering [1], system leaks [2, 3], and accuracy in volume and pressure delivery [4]. About 19% of patients in China developed hypoxic respiratory failure and required certain level of ventilation support [6].The situation in other countries is similar. Patients with COVID-19 show various phenotypes that may require different respiratory treatments, characterized as low compliance (LC) due to lung collapse or high airway resistance due to inflammation and mucus [7, 8]. The performance of ventilator could be various for different phenotypes, which was not well-studied. Since the number of infected patients is large and still increases dramatically, a large number of ventilators required to support patients’ respiratory system [9]. A welldesigned scoring system may be helpful for the evaluation and improvement of the ventilators
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