Accuracy of tidal volume delivery by paediatric intensive care ventilators: A bench-model study

Meryl Vedrenne-Cloquet; Samuel Tuffet; Bruno Louis; Sonia Khirani; Charlotte Collignon; Sylvain Renolleau; Brigitte Fauroux; Guillaume Carteaux

doi:10.1016/j.aucc.2023.12.007

Accuracy of tidal volume delivery by paediatric intensive care ventilators: A bench-model study

Aust Crit Care. 2024 Jan 23:S1036-7314(24)00005-5. doi: 10.1016/j.aucc.2023.12.007. Online ahead of print.

Authors

Meryl Vedrenne-Cloquet¹, Samuel Tuffet², Bruno Louis³, Sonia Khirani⁴, Charlotte Collignon⁵, Sylvain Renolleau⁶, Brigitte Fauroux⁷, Guillaume Carteaux²

Affiliations

¹ Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France; Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France. Electronic address: meryl_vedrenne@yahoo.fr.
² INSERM, Université Paris Est Créteil IMRB, CNRS EMR, 7000, Créteil, France; GRC CARMAS, IMRB, Université Paris Est Créteil, Faculté de Santé de Créteil, Créteil, France; Réanimation Médicale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
³ INSERM, Université Paris Est Créteil IMRB, CNRS EMR, 7000, Créteil, France.
⁴ Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France; ASV Santé, Gennevilliers, France.
⁵ Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France.
⁶ Université de Paris, Paris, France; Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France.
⁷ Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France.

PMID: 38267269
DOI: 10.1016/j.aucc.2023.12.007

Abstract

Background: Tidal volume (Vt) delivery during mechanical ventilation is influenced by gas compression, humidity, and temperature.

Objectives: This bench study aimed at assessing the accuracy of Vt delivery by paediatric intensive care ventilators according to the humidification system. Secondary objectives were to assess the following: (i) the accuracy of Vt delivery in ventilators with an integrated Y-piece pneumotachograph and (ii) the ability of ventilators to deliver and maintain a preset positive end-expiratory pressure.

Methods: Six latest-generation intensive care ventilators equipped with a paediatric mode were tested on the ASL5000 test lung in four simulated paediatric bench models (full-term neonate, infant, preschool-age chile, and school-age child), under volume-controlled mode with a heated humidifier (HH) or a heat moisture exchanger, with various loading conditions. Three ventilators equipped with a Y-piece pneumotachograph were tested with or without the pneumotachograph in the neonatal and infant models. "Accurate Vt" delivery was defined as a volume error (percentage of the preset Vt under body temperature and pressure and saturated water vapour conditions) being ≤10 % of the absolute preset value.

Results: Vt accuracy varied significantly across ventilators but was acceptable in almost all the ventilators and all the models, except the neonatal model. The humidification system had an impact on Vt delivery in the majority of the tested conditions (p < 0.05). The use of an HH was associated with a better Vt accuracy in four ventilators (V500, V800, R860, and ServoU) and allowed to achieve an acceptable level of volume error in the neonatal model as compared to the use of heat moisture exchanger. The use of an integrated pneumotachograph was associated with lower volume error in only one ventilator (p < 0.01). All the tested ventilators were able to maintain adequate positive end-expiratory pressure levels.

Conclusion: The humidification system affects Vt accuracy of paediatric intensive care ventilators, especially in the youngest patients for whom the HH should be preferred.

Keywords: Bench study; Heat moisture exchanger; Heated humidifier; Paediatric intensive care unit; Volume-controlled ventilation.