Accuracy of P0.1 measurements performed by ICU ventilators: a bench study

Background

Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators

Methods

Five ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1_vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H_2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1_ref). The pressure drop after 100 ms was measured offline on the airway pressure–time curves recorded during the automated P0.1 measurements (P0.1_aw). P0.1_vent was compared to P0.1_ref and to P0.1_aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1_circuit)

Results

Variations of P0.1_vent correlated well with variations of P0.1_ref. Overall, P0.1_vent underestimated P0.1_ref except for the Löwenstein^® ventilator at P0.1_ref 2.5 cm H_2O and for the Getinge group^® ventilator at P0.1_ref 10 cm H_2O. The agreement between P0.1_vent and P0.1_ref assessed with the Bland–Altman method gave a mean bias of − 1.3 cm H_2O (limits of agreement: 1 and − 3.7 cm H_2O). Analysis of airway pressure–time and flow–time curves showed that all the tested ventilators except the Getinge group^® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1_vent and P0.1_aw assessed with the Bland–Altman method gave a mean bias of 0.5 cm H_2O (limits of agreement: 2.4 and − 1.4 cm H_2O). The circuit’s length impacted P0.1 measurements’ values. A longer circuit was associated with lower P0.1_circuit values. Conclusion P0.1_vent relative changes are well correlated to P0.1_ref changes in all the tested ventilators. Accuracy of absolute values of P0.1_vent varies according to the ventilator model. Overall, P0.1_vent underestimates P0.1_ref. The length of the circuit may partially explain P0.1_vent underestimation.