Reliability and limits of transport-ventilators to safely ventilate severe patients in special surge situations

  1. Dominique Savary
  2. Arnaud Lesimple
  3. François Beloncle
  4. François Morin
  5. François Templier
  6. Alexandre Broc
  7. Laurent Brochard
  8. Jean-Christophe Richard
  9. Alain Mercat

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Abstract

Background

Several Intensive Care Units (ICU) have been overwhelmed by the surge of COVID-19 patients thus necessitating to extend ventilation capacity outside the ICU where air and oxygen pressure are not always available. Transport ventilators requiring only O 2 source may be used to deliver volume-controlled ventilation.

Objective

To evaluate the performances of four transport ventilators compared to an ICU ventilator simulating severe respiratory conditions.

Materials and methods

Two pneumatic transport ventilators, (Oxylog 3000, Draeger; Osiris 3, Air Liquide Medical Systems) and two turbine transport ventilators (Elisee 350, ResMed; Monnal T60, Air Liquide Medical Systems) were compared to an ICU ventilator (Engström Carestation – GE Healthcare) using a Michigan training test lung. We tested each ventilator with different set volumes Vt set (350, 450, 550 ml) and different compliances (20 or 50 ml/cmH 2 O) and a resistance of 15 cmH 2 0/L/sec based on values recently described in COVID-19 Acute Respiratory Distress Syndrome. Volume error was measured, as well as the trigger time delay during assist-control ventilation simulating spontaneous breathing activity with a P 0.1 of 4 cmH 2 0.

Results

Grouping 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, trigger delay was 42 ± 4 ms, 65 ± 5 ms, 151 ± 14 ms, 51 ± 6 and 64 ± 5 ms for Engström Carestation, Osiris 3, Oxylog 3000, Monnal T60 and Elisee 350, respectively.

Conclusions

In special surge situations such as COVID-19 pandemic, most transport ventilators may be used to safely deliver volume-controlled ventilation in locations where only oxygen pressure supply is available with acceptable volume accuracy. Performances regarding triggering function are generally acceptable but vary across ventilators.

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  1. ScreenIT

    SciScore for 10.1101/2020.10.07.20208561: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.10.07.20208561 on medRxiv
  3. Version published to 10.1186/s13613-020-00782-5