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1. Continuous positive airway pressure titration in infants with severe upper airway obstruction or bronchopulmonary dysplasia

Author

Nicolas Leboulanger, Sabrina Aloui, Arnaud Picard, Adriana Ramirez, Brigitte Fauroux, Sonia Khirani, S2A santé Île-de-France, S2A Santé, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Oxygénothérapie, ADEP assistance, INSERM U955, équipe 13, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM), Vaincre la Mucoviscidose (VLM), Assistance Publique-Hôpitaux de Paris, Inserm, Université Pierre et Marie Curie-Paris 6, ADEP Assistance, S2A Santé, and IP Santé Domicile., and BMC, Ed.

Subjects
Male, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], medicine.medical_treatment, Continuous positive airway pressure, Critical Care and Intensive Care Medicine, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Severity of illness, Respiratory muscle, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Humans, Medicine, Single-Blind Method, 030212 general & internal medicine, Bronchopulmonary Dysplasia, business.industry, Continuous positive airway pressure titration, Research, Oesophageal pressure, Infant, Airway obstruction, medicine.disease, nervous system diseases, respiratory tract diseases, 030228 respiratory system, Bronchopulmonary dysplasia, Anesthesia, Breathing, Female, Expiratory abdominal activity, business, therapeutics, circulatory and respiratory physiology
Abstract

International audience; INTRODUCTION: Noninvasive continuous positive airway pressure (CPAP) is recognized as an effective treatment for severe airway obstruction in young children. The aim of the present study was to compare a clinical setting with a physiological setting of noninvasive CPAP in infants with nocturnal alveolar hypoventilation due to severe upper airway obstruction (UAO) or bronchopulmonary dysplasia (BPD). METHODS: The breathing pattern and respiratory muscle output of all consecutive infants due to start CPAP in our noninvasive ventilation unit were retrospectively analysed. CPAP set on clinical noninvasive parameters (clinical CPAP) was compared to CPAP set on the normalization or the maximal reduction of the oesophageal pressure (Poes) and transdiaphragmatic pressure (Pdi) swings (physiological CPAP). Expiratory gastric pressure (Pgas) swing was measured. RESULTS: The data of 12 infants (mean age 10 ± 8 mo) with UAO (n = 7) or BPD (n = 5) were gathered. The mean clinical CPAP (8 ± 2 cmH₂O) was associated with a significant decrease in Poes and Pdi swings. Indeed, Poes swing decreased from 31 ± 15 cmH₂O during spontaneous breathing to 21 ± 10 cmH₂O during CPAP (P < 0.05). The mean physiological CPAP level was 2 ± 2 cmH2₂O higher than the mean clinical CPAP level and was associated with a significantly greater improvement in all indices of respiratory effort (Poes swing 11 ± 5 cm H₂O; P < 0.05 compared to clinical CPAP). Expiratory abdominal activity was present during the clinical CPAP and decreased during physiological CPAP. CONCLUSIONS: A physiological setting of noninvasive CPAP, based on the recording of Poes and Pgas, is superior to a clinical setting, based on clinical noninvasive parameters. Expiratory abdominal activity was present during spontaneous breathing and decreased in the physiological CPAP setting.

Published
2013
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2. Evaluation of the trachea and intrathoracic airways by the acoustic reflection method in children with cystic fibrosis

Author

Redouane Fodil, Bruno Louis, N. Leboulanger, Adriana Ramirez, Harriet Corvol, Frédéric Lofaso, Brigitte Fauroux, Régénération et croissance de l'axone = Axonal Growth and Regeneration (NPS-12), Neuroscience Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), French association against cystic fibrosis (Vaincre la Mucoviscidose, VLM), French Association against Myopathies (Association francaise contre les myopathies, AFM), Assistance Publique-Hopitaux de Paris, INSERM, ADEP Assistance, Universite Pierre et Marie Curie, Societe Francaise d'ORL (SFORL), Neurosciences Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Physiology, Bronchi, 030204 cardiovascular system & hematology, Cystic fibrosis, 03 medical and health sciences, 0302 clinical medicine, Airway resistance, Older patients, medicine, Airways, Humans, Acoustic reflection, Child, Tracheomalacia, business.industry, General Neuroscience, Respiration, Acoustics, medicine.disease, Control subjects, Surgery, Trachea, 030228 respiratory system, Case-Control Studies, Child, Preschool, Breathing, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Nuclear medicine, business, Airway
Abstract

International audience; Tracheomalacia has been observed in older patients with cystic fibrosis (CF). The acoustic reflection method (ARM) allows a noninvasive calculation of the longitudinal cross-sectional area of the trachea (MTAv) and the airway resistance (Raw). ARM measurements were performed in 20 CF children and 20 controls during spontaneous breathing (SB), forced inspiration (FI), and forced expiration (FE). The mean MTAv value was comparable in the CF patients and the control subjects during SB, FI, and FE. The Raw was also comparable during SB and FI. However, the Raw during FE was higher in the CF patients than in the control subjects (7.9 +/- 2.3 vs 5.0 +/- 1.5 cmH(2)Ol(-1) s(-1), respectively, p < 0.001). In the patients with CF, only the Raw during FE correlated with the predicted forced expiratory volume in 1 s (R-2 = 0.37, p = 0.04). The tracheal cross-sectional area measured by the ARM is normal in children with CF but the increase in Raw during FE suggests an increase in intrathoracic airway distensibility.

Published
2012
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3. Effect of manufacturer-inserted mask leaks on ventilator performance

Author

Karl Leroux, Bruno Louis, Brigitte Fauroux, Frédéric Lofaso, Daniel Isabey, INSERM U955, équipe 13, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), ADEP assistance, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre d’Investigation Clinique 1429 [Garches] (CIC 1429), Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Association d'Entraide des Polios et Handicapés (ADEP), Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and Guellaen, Georges

Subjects
Pulmonary and Respiratory Medicine, Adult, Leak, medicine.medical_specialty, Patient-ventilator synchrony, Pulmonary disease, MESH: Equipment Failure Analysis, Mascara, MESH: Ventilators, Mechanical, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, MESH: Positive-Pressure Respiration, 0302 clinical medicine, law, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Medicine, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, Simulation, Ventilators, Mechanical, MESH: Humans, MESH: Middle Aged, business.industry, Masks, MESH: Adult, Equipment Design, Middle Aged, Leaks, Interface, Surgery, Equipment Failure Analysis, On ventilator, Trigger, 030228 respiratory system, MESH: Masks, Ventilation (architecture), Noninvasive ventilation, business, MESH: Equipment Design
Abstract

International audience; Most pressure-support devices use a single circuit with an exhalation port integrated in the mask. The aim of the current study was to compare the effects of masks having different manufacturer-inserted leaks on ventilator performance. We simulated chronic obstructive pulmonary disease and restrictive disease. Four ventilators (VENTImotion (Weinmann, Hamburg, Germany), VPAP III STA (ResMed, Saint Priest, France), Synchrony 2 (Respironics, Nantes, France) and Vivo 40 (Breas, Saint Priest)) were tested with the recommended masks and with the masks having the largest and smallest leaks. Tests were performed with pressure support levels of 10, 15 and 20 cmH(2)O. The in vivo evaluation compared two ventilators using recommended masks opposed in terms of exhaled port resistance. The ventilators were tested with their recommended mask, and after mask exchange. The mask with the largest leak induced auto-triggering and/or increased inspiratory-trigger sensitivity was the VENTImotion under both simulated conditions and VPAP III STA under the simulated obstructive-disease condition. The mask with the smallest leak-increased inspiratory-trigger delay was Synchrony 2 in the simulated obstructive-disease condition and increased rebreathing. The in vivo study confirmed the bench results. When switching to a mask that has a different leak, evaluation is needed to adjust trigger sensitivity and pressurisation level and to check the absence of rebreathing.

Published
2010
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4. Pressure stability with CPAP devices: A bench evaluation

Author

Frédéric Lofaso, Véronique Grillier-Lanoir, Karl Leroux, Bruno Louis, Brigitte Fauroux, Maud Boucherie, Daniel Isabey, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), ADEP assistance, Respiratory division, Covidien, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique 1429 [Garches] (CIC 1429), Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Guellaen, Georges, CHU Trousseau [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Leak, MESH: Continuous Positive Airway Pressure, obstructive sleep apnoea, medicine.medical_treatment, MESH: Equipment Failure Analysis, Pulmonary compliance, MESH: Pulmonary Ventilation, leak effects, Positive-Pressure Respiration, 03 medical and health sciences, Work of breathing, MESH: Positive-Pressure Respiration, 0302 clinical medicine, Airway resistance, MESH: Computer Simulation, MESH: Airway Resistance, work of breathing, MESH: Humidity, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, medicine, Humans, Computer Simulation, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Continuous positive airway pressure, Lung Compliance, bench test, Pressure drop, MESH: Humans, business.industry, Airway Resistance, Humidity, General Medicine, respiratory tract diseases, Equipment Failure Analysis, Compliance (physiology), MESH: Work of Breathing, 030228 respiratory system, Constant pressure, Anesthesia, Pulmonary Ventilation, business, MESH: Lung Compliance, 030217 neurology & neurosurgery, continuous positive airway pressure
Abstract

International audience; BACKGROUND: Continuous positive airway pressure (CPAP) maintains a constant pressure to reduce the patient's work of breathing (WOB). The aim of this study was to measure the additional WOB imposed by four current CPAP devices during simulation of a difficult but commonly encountered clinical situation. METHOD: Flow contour, respiratory system compliance and total lung-airway resistance of a patient under CPAP were simulated. The devices were tested at a CPAP of 15cm H(2)O with a heated humidifier and a nasal pillow, which increased circuitry resistance and with and without a simulated unintentional leak. RESULTS: With no leak, positive end-expiratory pressure (PEEP) at the interface varied across devices from 14.0 to 15.3cm H(2)O. With a leak of 1L/s, PEEP varied from 11.5 to 17.1cm H(2)O. Imposed inspiratory WOB ranged from less than 0.1J/min to 0.45J/min with no leak, and the range broadened with leaking. Findings were similar for the imposed expiratory WOB. CONCLUSION: The performances of CPAP devices are variable. The device that calibrated for the pressure loss in the circuitry under dynamic conditions and made appropriate pressure adjustments outperformed the other devices.

Published
2010
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5. ventilators for noninvasive ventilation

Author

Annick Clement, Frédéric Lofaso, Karl Leroux, Bruno Louis, Gilbert Desmarais, Brigitte Fauroux, Daniel Isabey, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Physiologie, biologie des organismes, populations, interactions, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), ADEP assistance, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], The research of BF is supported by the Association Française contre les Myopathies (AFM), Assistance Publique-Hôpitaux de Paris, Inserm, Legs Poix, and Université Pierre et Marie Curie-Paris6., CHU Trousseau [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Pulmonary and Respiratory Medicine, Artificial ventilation, Adult, medicine.medical_specialty, Adolescent, Home Nursing, medicine.medical_treatment, Positive pressure, law.invention, Home ventilation, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, law, Medicine, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, Positive pressure ventilation, Intensive care medicine, Tidal volume, Mechanical ventilation, Ventilators, Mechanical, business.industry, Infant, Equipment Design, 030228 respiratory system, Anesthesia, Child, Preschool, Ventilation (architecture), Equipment Failure, business, Airway
Abstract

International audience; The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France. The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles. The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient's inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients. A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.

Published
2008
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