• Barbara Moro, Loredana Baboi, Hodane Yonis, Fabien Subtil, Bruno Louis, and Claude Guérin.
• Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
• Respir Care. 2018 Oct 1; 63 (10): 1253-1263.

BackgroundDuring extracorporeal membrane oxygenation for ARDS, a range of 1-4 mL/kg predicted body weight tidal volume (VT) is commonly used. We explored whether such a low VT could be adequately delivered by ICU ventilators, and whether such low VTs prevent the heated humidifier (HH) from reaching the recommended target of 33 mg/L absolute humidity (AH).MethodsWe attached a lung model to 5 ICU ventilators set in volume controlled mode and body temperature and pressure saturated. We ran 2 protocols over a 100-280 mL VT range used with adult or neonatal breathing circuit at a breathing frequency (f) of 15 (f15) or 30 (f30) breaths/min. In the first protocol, with the HH off, VT was measured with a dedicated data logger and expressed in body temperature and pressure saturated. The relationships of measured VT to set VT were studied, and the relative error in VT was analyzed within its 10% boundaries. In the second protocol, the HH was on, and we measured AH using a psychrometric method. The relationship of AH to set VT was analyzed with linear regression.ResultsFor the 5 ventilators used, the slope (95% CI) between measured VT versus set VT averaged 0.93 (0.92-0.93), 0.93 (0.93-0.94), 0.91 (0.90-0.91), and 0.91 (0.90-0.91) mL/mL for adult and neonatal circuits at f15 and f30, respectively (P < .05 vs 1 in each instance), indicating a systematic under-delivery of VT. The VT relative error fell within the ±10% accuracy range for only 2 ventilators with adult circuits at f15 and f30. AH increased linearly with VT. The recommended target of 33 mg/L AH was reached with all of the ventilators for the adult circuit at f30 only. The minimum volume that met the recommended threshold for AH was 100, 150, 190, 160, and 100 mL for the G5, Carestation, PB980, Servo-U, and V500 ventilators, respectively, at f30.ConclusionLow VT was systematically under-delivered by modern ICU ventilators by roughly 7-9%. To meet the recommended target of 33 mg/L AH, adult circuit at f30 should be used.Copyright © 2018 by Daedalus Enterprises.

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