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Article Dans Une Revue Critical Care Année : 2023

A new reservoir-based CPAP with low oxygen consumption: the Bag-CPAP

Eloïse de Beaufort
  • Fonction : Auteur
Guillaume Carteaux
  • Fonction : Auteur
François Morin
  • Fonction : Auteur
Arnaud Lesimple
  • Fonction : Auteur
Anne-Fleur Haudebourg
  • Fonction : Auteur
Emeline Fresnel
  • Fonction : Auteur
Damien Duval
  • Fonction : Auteur
Alexandre Broc
  • Fonction : Auteur
Alain Mercat
  • Fonction : Auteur
Laurent Brochard
  • Fonction : Auteur
Dominique Savary
François Beloncle
  • Fonction : Auteur
Jean-Christophe Richard
  • Fonction : Auteur

Résumé

Abstract Background Several noninvasive ventilatory supports rely in their design on high oxygen consumption which may precipitate oxygen shortage, as experienced during the COVID-19 pandemic. In this bench-to-bedside study, we assessed the performance of a new continuous positive airway pressure (CPAP) device integrating a large reservoir (“Bag-CPAP”) designed to minimize oxygen consumption, and compared it with other CPAP devices. Methods First, a bench study compared the performances of Bag-CPAP and four CPAP devices with an intensive care unit ventilator. Two FiO 2 targets (40–60% and 80–100%) at a predefined positive end expiratory pressure (PEEP) level between 5 and 10 cm H 2 O were tested and fraction of inspired oxygen (FiO 2 ) and oxygen consumption were measured. Device-imposed work of breathing (WOB) was also evaluated. Second, an observational clinical study evaluated the new CPAP in 20 adult patients with acute respiratory failure in two hospitals in France. Actual FiO 2 , PEEP, peripheral oxygen saturation, respiratory rate, and dyspnea score were assessed. Results All six systems tested in the bench study reached the minimal FiO 2 target of 40% and four reached at least 80% FiO 2 while maintaining PEEP in the predefined range. Device-delivered FiO 2 /consumed oxygen ratio was the highest with the new reservoir-based CPAP irrespective of FiO 2 target. WOB induced by the device was higher with Bag-CPAP. In the clinical study, Bag-CPAP was well tolerated and could reach high (> 90%) and moderate (> 50%) FiO 2 with an oxygen flow rate of 15 [15–16] and 8 [7–9] L/min, respectively. Dyspnea score improved significantly after introduction of Bag-CPAP, and SpO 2 increased. Conclusions In vitro, Bag-CPAP exhibited the highest oxygen saving properties albeit had increased WOB. It was well accepted clinically and reduced dyspnea. Bag-CPAP may be useful to treat patients with acute respiratory failure in the field, especially when facing constraints in oxygen delivery.

Dates et versions

hal-04389505 , version 1 (11-01-2024)

Identifiants

Citer

Eloïse de Beaufort, Guillaume Carteaux, François Morin, Arnaud Lesimple, Anne-Fleur Haudebourg, et al.. A new reservoir-based CPAP with low oxygen consumption: the Bag-CPAP. Critical Care, 2023, 27 (1), pp.262. ⟨10.1186/s13054-023-04542-2⟩. ⟨hal-04389505⟩

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