In vitro assessment of proportional assist ventilation.

OBJECTIVE

During proportional assist ventilation (PAV) the timing and frequency of inflations are controlled by the patient and the patient's work of breathing may be relieved by elastic and/or resistive unloading. It is important and the authors' objective to determine whether ventilators delivering PAV function well in situations mimicking neonatal respiratory conditions.

DESIGN

In vitro laboratory study.

SETTING

Tertiary neonatal ICU.

INTERVENTIONS: Dynamic lung models were developed which mimicked respiratory distress syndrome, bronchopulmonary dysplasia and meconium aspiration syndrome to assess the performance of the Stephanie neonatal ventilator.

MAIN OUTCOME MEASURES: The effects of elastic and resistive unloading on inflation pressures and airway pressure wave forms and whether increasing unloading was matched by an 'inspiratory' load reduction.

RESULTS

During unloading, delivered pressures were between 1 and 4 cm H(2)O above those expected. Oscillations appeared in the airway pressure wave form when the elastic unloading was greater than 0.5 cm H(2)O/ml with a low resistance model and 1.5 cm H(2)O/ml with a high resistance model and when the resistive unloading was greater than 100 cm H(2)O/l/s. There was a time lag in the delivery of airway pressure of at least 60 ms, but increasing unloading was matched by an inspiratory load reduction.

CONCLUSIONS

During PAV, unloading does reduce inspiratory load, but there are wave form abnormalities and a time lag in delivery of the inflation pressure. The impact of these problems needs careful evaluation in the clinical setting.