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The Difference Between Set and Delivered Tidal Volume: A Lung Simulation Study

Authors Yamaguchi Y, Miyashita T, Matsuda Y, Sasaki M, Takaki S, Kim SS, Tobias JD, Goto T

Received 3 May 2020

Accepted for publication 30 June 2020

Published 12 July 2020 Volume 2020:13 Pages 205—211


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Yoshikazu Yamaguchi,1– 3 Tetsuya Miyashita,1 Yuko Matsuda,1 Makoto Sasaki,1 Shunsuke Takaki,1 Stephani S Kim,2 Joseph D Tobias,2,3 Takahisa Goto1

1Department of Anesthesiology and Critical Care, Yokohama City University, Kanagawa, Japan; 2Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 3Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Correspondence: Yoshikazu Yamaguchi
Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
Tel +1 (614) 722-4200
Fax +1 (614) 722-4203

Background: Precise control of tidal volume is one of the keys in limiting ventilator-induced lung injury and ensuring adequate ventilation in mechanically ventilated neonates. The aim of the study was to compare the tidal volume (mVT) measured from the expiratory limb of the ventilator with the actual tidal volume (aVT) that would be delivered to the patient using a lung model to simulate a neonate.
Methods: This study was conducted using the ASL5000 lung simulator. Three combinations of parameters were set: resistance (cmH2O/L/sec) and compliance (mL/cmH2O) of 50 and 2 (Group 1), 100 and 1 (Group 2), and 150 and 0.5 (Group 3), respectively. The ASL5000 was connected to each of the ventilators including one anesthesia machine ventilator (Drager Fabius GS) and two ICU ventilators (Servo-i Universal and Evita Infinity V500). Each ventilator was evaluated with a set tidal volume of 30 mL (sVT) and a respiratory rate of 25 breathes/minute in both the volume-controlled ventilation (VCV) and dual-controlled ventilation (DCV) modes.
Results: The discrepancies between sVT, mVT and aVT were highest with the Fabius anesthesia machine ventilator and increased in the simulated lung injury groups. When comparing the ICU ventilators, the difference was greater the Servo-i and increased when using the DCV mode and with simulated lung injury.
Conclusion: Accurate tidal volumes were achieved only with the Infinity ICU ventilator. This was true regardless of mode of ventilation and even during simulated lung injury.

Keywords: mechanical ventilation, pediatric anesthesia, tidal volume, flow sensor, lung protective ventilation, volutrauma

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