Assessment of Infant Volume-Targeted Mode Performance Between ICU and Transport Ventilators

Abstract

Background:

Volume-targeted ventilation modes are used in NICU and neonatal transports to provide consistent and accurate tidal volume (V_T) delivery so that gas exchange and lung protection can be optimized. We hypothesized there would be no differences in V_T delivery in infant lung models between an ICU (Draeger VN500, Lubeck, Germany) and Transport (Hamilton T1, Reno, NV).

Methods:

The Hamilton T1 and VN500 were configured in AC-VG using standard 6 mL/kg settings for ELBW and term newborn. The Ingmar ASL 5000 ventilator was configured using a customized compliance and resistance for each model. The displayed V_T on the ventilator and V_T delivery to ASL were recorded both from Standby to ON for 8 breaths and following 1 minute after V_T was stabilized. Mean differences between % error and bias between the ventilators were compared using T-test with significance established as P < .05.

Results:

When Hamilton T100 was set to deliver V_T 6 mL/kg in the ELBW model, excessive V_T (∼16 mL/kg) was observed for 8-10 breaths; whereas Draeger VN remained stable with 6-7 mL/kg. The Draeger had greater accuracy than Hamilton with ELBW (P < .05) testing but was lower when compared to Hamilton with term newborn testing (P < .05). The % error was within 10% for term newborns with each ventilator. The Hamilton reported lower V_T (∼2 mL) than what was delivered to the lung model, whereas Draeger VN was within 1 mL for both ELBW and term newborn.

Conclusions:

There may be important differences in V_T accuracy and reported values between ICU and transport ventilators to considering when proving lung protection to infants.