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Volume-targeted ventilation with a Fabian ventilator: maintenance of tidal volumes and blood CO2
  1. Gusztav Belteki1,2,
  2. András Széll2,
  3. Lajos Lantos2,
  4. Gabor Kovács2,
  5. Gyula Szántó2,
  6. Aniko Berényi2,
  7. Mónika Szilágyi2,
  8. Gábor Liszkay2,
  9. Ferenc Kőhalmi2,
  10. Colin J Morley1,
  11. Zsolt Somogyvári2,3
  1. 1Neonatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Neonatal Emergency and Transport Services of the Peter Cerny Foundation, Budapest, Hungary
  3. 3Department of Family Care and Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
  1. Correspondence to Dr Gusztav Belteki, Department of Neonatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK; gbelteki{at}aol.com

Abstract

Objective To analyse the performance of the Fabian +NCPAP evolution ventilator during volume guarantee (VG) ventilation in neonates at maintaining the target tidal volume and what tidal and minute volumes are required to maintain normocapnia.

Methods Clinical and ventilator data were collected and analysed from 83 infants receiving VG ventilation during interhospital transfer. Sedation was used in 26 cases. Ventilator data were downloaded with a sampling rate of 0.5 Hz. Data were analysed using the Python computer language and its data analysis packages.

Results ~107 hours of ventilator data were analysed, consisting of ~194 000 data points. The median absolute difference between the actual expiratory tidal volume (VTe) of the ventilator inflations and the target tidal volume (VTset) was 0.29 mL/kg (IQR: 0.11–0.79 mL/kg). Overall, VTe was within 1 mL/kg of VTset in 80% of inflations. VTe decreased progressively below the target when the endotracheal tube leak exceeded 50%. When leak was below 50%, VTe was below VTset by >1 mL/kg in less than 12% of inflations even in babies weighing less than 1000 g. Both VTe (r=−0.34, p=0.0022) and minute volume (r=−0.22, p=0.0567) showed a weak inverse correlation with capillary partial pressure of carbon dioxide (Pco2) values. Only 50% of normocapnic blood gases were associated with tidal volumes between 4 and 6 mL/kg.

Conclusions The Fabian ventilator delivers volume-targeted ventilation with high accuracy if endotracheal tube leakage is not excessive and the maximum allowed inflating pressure does not limit inflations. There is only weak inverse correlation between tidal or minute volumes and Pco2.

  • respiratory
  • technology
  • monitoring
  • intensive care
  • neonatology
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Footnotes

  • Contributors GB designed the study, wrote the computer programs to analyse ventilator data, performed the data analysis and drafted the manuscript. AS, LL, GK, AB, MS, GL, FK and ZS performed the neonatal transfers and collected the clinical data. GS integrated the data downloading software and computer in the transport equipment. CJM helped with the interpretation of findings. All authors revised and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CJM was a consultant to Acutronic Medical but not for Fabian ventilators.

  • Ethics approval The study was approved by the Scientific and Medical Research Council Ethics Committee of Hungary (reference: 40158-2/2018/EKU).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Upon acceptance of the paper we will upload the Python code of the data analysis workflow to the GitHub code repository.

  • Patient consent for publication Not required.

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