Monitoring of Ventilation and Air Leakage during CPAP. Gerd Schmalisch. Clinic of Neonatology Charité-Universitätsmedizin Berlin. Outline. Ventilation and air leakage measurements during MV Peculiarities of ventilation monitoring during CPAP Theoretical background
Clinic of Neonatology
Displayed air leakage:
Mahmoud R, et al. Acta Paediatr. 98 (2009) 1116-1122
Frequency distribution of ET leakage of 163 ventilated (>5h) newborns
No ET leakage:
ET leakage < 20%:
ET leakage >40%:
Temporarily ET leakage >40% during MV
No suitable equipment !
Schmalisch G. Yearbook equipments and technology in NIPPV - 2009
How we can separate breathing flow and leakage flow?
(Prerequisite for breath detection and ventilation measurements)
Under this conditions is the separation of breathing flow and leakage flow is a big challenge!
Schmalisch G. Year book of NIPPV 2009
The quantification of air leakages by the leak flow is more informative than by the currently use of percentages.
- modeling and in-vitro measurements -
V`E - measured minute ventilation
maxV‘CPAP - maximal CPAP flow
Tin/Tex - inspiratory/expiratory time
Schmalisch G, et al. Med. Eng Phys. 31 (2009) 124-130
Fischer HS,, et al. Physiol. Meas. 29 (2008) 95-107
- in vitro study -
Hückstädt T et al. Intens. Care Med. 29 (2003) 1134-1140
Clinical cross-over study N=69
Fischer HS, et al. Intens. Care Med. (2009) (in press)
Clinical cross-over study N=32
* After BTPS Correction
1) Schmalisch G, et al. BMC Pediatrics 2009
Nasopharyngeal CPAP with occluded contralateral nostril
Fischer HS, et al. Intens. Care Med. 2009 (in press)
Consequences of air leakages during nasal mask ventilation in adults
Rabec CA et al. Leak Monitoring in Noninvasive Ventilation. Arch Bronconeumol 2004;40(11):508-17
What is relevant for the CPAP treatment in newborns?