Effect of air leak on the performance of auto-PAP devices: A bench study

被引：26

作者：

Coller D. ^{[1
]}

Stanley D. ^{[2
]}

Parthasarathy S. ^{[3
]}

机构：

[1] Metropolitan Hospital, Grand Rapids, MI

[2] Critical Care and Pulmonary Consultants, Aurora, CO

[3] Section of Pulmonary and Critical Care Medicine, Southern Arizona VA Healthcare System, Tucson, AZ 85723

来源：

Sleep and Breathing | 2005年 / 9卷 / 4期

关键词：

Algorithms; Equipment design; Positive-pressure respiration; Respiration; Sleep apnea;

D O I：

10.1007/s11325-005-0032-z

中图分类号：

学科分类号：

摘要：

Automatic positive airway pressure (auto-PAP) devices, used in the treatment of patients with obstructive sleep apnea (OSA), may not function optimally in the presence of an air leak. We set out to determine the magnitude of air leak that prevents auto-PAP devices from responding to respiratory events of OSA in a bench model. We simulated apnea, flow limitation, obstructive hypopnea, nonobstructive hypopnea, and snoring events of OSA with an artificial airway and a loudspeaker in a bench model connected to a commercially available auto-PAP device. Four auto-PAP devices were tested, but two of the "older-generation" devices (Tranquility and Virtuoso) did not respond to events of OSA that involved changes in flow contour; hence, we studied the effects of air leak and humidifier in the two "newer-generation" auto-PAP devices only (GoodKnight 418P, Autoset-T). When the air leak was progressively increased from baseline levels recommended by the manufacturer to levels seen clinically - 5 to 7, 10, and 30 l/min - the GoodKnight 418P decreased pressure response by 56% (5.6±1.8 cm H2O, p=0.04). The pressure response of the Autoset-T, however, did not change from baseline during similar levels of air leak. The GoodKnight performed appropriately when the air leak was within 20 l/min, but the corresponding value for the Autoset was higher at 50 l/min. For both devices combined, air leak caused the pressure to drop between the device and the airway: 2.8±0.3 cm H2O at 30 l/min of air leak (p<0.001). Air leaks cause auto-PAP devices to underestimate the pressure required to treat events of OSA and to overestimate the pressure delivered at the upper airway. Physicians should be aware of performance limitations of auto-PAP devices in the presence of an air leak. © Springer-Verlag 2005.

引用

页码：167 / 175

页数：8

共 26 条

[1]

Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes, Am J Respir Crit Care Med, 150, pp. 1738-1745, (1994)

[2]

Sullivan C.E., Issa F.G., Berthon-Jones M., Eves L., Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares, Lancet, 1, pp. 862-865, (1981)

[3]

Berry R.B., Parish J.M., Hartse K.M., The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. An American Academy of Sleep Medicine review, Sleep, 25, pp. 148-173, (2002)

[4]

Littner M., Hirshkowitz M., Davila D., Et al., Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report, Sleep, 25, pp. 143-147, (2002)

[5]

Senn O., Brack T., Matthews F., Russi E.W., Bloch K.E., Randomized short-term trial of two autoCPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea, Am J Respir Crit Care Med, 168, pp. 1506-1511, (2003)

[6]

Planes C., D'Ortho M.P., Foucher A., Berkani M., Leroux K., Essalhi M., Delclaux C., Quera-Salva M.A., Lofaso F., Efficacy and cost of home-initiated auto-nCPAP versus conventional nCPAP, Sleep, 26, pp. 156-160, (2003)

[7]

Hudgel D.W., Fung C., A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure, Sleep, 23, pp. 645-648, (2000)

[8]

Lloberes P., Ballester E., Montserrat J.M., Et al., Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome, Am J Respir Crit Care Med, 154, pp. 1755-1758, (1996)

[9]

Teschler H., Berthon-Jones M., Intelligent CPAP systems: Clinical experience, Thorax, 53, (1998)

[10]

Meurice J.C., Marc I., Series F., Efficacy of auto-CPAP in the treatment of obstructive sleep apnea/ hypopnea syndrome, Am J Respir Crit Care Med, 153, pp. 794-798, (1996)

← 1 2 3 →