Original Articles
Leak Monitoring in Noninvasive Ventilation
C.A. Rabec
, O. Reybet-Degat, P. Bonniaud, A. Fanton, P. Camus
Corresponding author
claudio.rabec@chu-dijon.fr
Correspondence: Dr. C.A. Rabec. Service de Pneumologie et Réanimation Respiratoire. Centre Hospitalier et Universitaire de Dijon. 2 Bd Marechal de Lattre de Tassigny. 21079 Dijon Cedex France
Correspondence: Dr. C.A. Rabec. Service de Pneumologie et Réanimation Respiratoire. Centre Hospitalier et Universitaire de Dijon. 2 Bd Marechal de Lattre de Tassigny. 21079 Dijon Cedex France
Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, France
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Rabec, O. Reybet-Degat, P. Bonniaud, A. Fanton, P. Camus" "autores" => array:5 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "C.A." "apellidos" => "Rabec" "email" => array:1 [ 0 => "claudio.rabec@chu-dijon.fr" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Reybet-Degat" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Bonniaud" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Fanton" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Camus" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, France" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. C.A. Rabec. Service de Pneumologie et Réanimation Respiratoire. Centre Hospitalier et Universitaire de Dijon. 2 Bd Marechal de Lattre de Tassigny. 21079 Dijon Cedex France" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-12-02" "fechaAceptado" => "2004-04-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec153183" "palabras" => array:5 [ 0 => "Noninvasive ventilation" 1 => "Monitoring" 2 => "Leaks" 3 => "Respiratory insufficiency" 4 => "Sleep apnea-hypopnea syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153182" "palabras" => array:5 [ 0 => "Ventilación no invasiva" 1 => "Monitorización" 2 => "Fugas" 3 => "Insuficiencia respiratoria" 4 => "Síndrome de apnea del sueño" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Nasal mask ventilation has been shown to be effective, but outcomes do not always match expectations because of mouth leaks, patient-ventilator asynchrony, or decreased upper airway patency. These developments are detected when they lead ultimately to circuit leaks that lower the effectiveness of ventilation through pressure loss, poor inspiratory triggering, and prolonged inspiratory time. The quality of sleep is affected, and adverse effects and treatment intolerance may arise.</p><p class="elsevierStyleSimplePara elsevierViewall">A number of ways to detect leaks and their practical consequences are proposed in this article.</p><p class="elsevierStyleSimplePara elsevierViewall">We applied 310 leak-detection procedures to 177 patients who had disappointing clinical, gasometric, or polysomnographic outcomes of ventilation. The leak-detection procedures varied according to the type of ventilation and the supposed underlying pathophysiological mechanism. Significant leaks were detected in 132 patients (76%); therapeutic changes were then prescribed to optimize outcomes.</p><p class="elsevierStyleSimplePara elsevierViewall">We present a practical method to apply in patients with suboptimal ventilation outcomes. If leaks can be detected during treatment, the probable cause of treatment failure can sometimes be established and possible pathophysiological mechanisms better understood. With this knowledge, it may be possible to improve ventilation.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">La ventilación por mascarilla nasal ha dado sobradas pruebas de su eficacia. Sin embargo, en ciertos casos los re-sultados no son los esperados. Tres mecanismos pueden ex-plicar estos fallos: apertura bucal, desincronización pacien-te-respirador y disminución de la permeabilidad de la vía respiratoria superior. Éstos pueden detectarse por su mani-festación última: las fugas en el circuito, que reducen la eficacia de la ventilación (fallo de presurización, disfunción del <span class="elsevierStyleItalic">trigger</span> inspiratorio y prolongación del tiempo inspiratorio), alteran la calidad del sueño y producen efectos adversos e intolerancia al tratamiento.</p><p class="elsevierStyleSimplePara elsevierViewall">Proponemos aquí varias técnicas de detección de fugas y sus consecuencias prácticas.</p><p class="elsevierStyleSimplePara elsevierViewall">Se sometió a 177 pacientes, con resultados de la ventilación inferiores a los esperados (clínicos, gasométricos o poligráfi-cos), a 310 procedimientos de detección de fugas, con montajes que variaron según la modalidad ventilatoria y el mecanismo fisiopatológico juzgado como responsable. Se detectaron fugas significativas en 132 pacientes (76%), lo cual impuso modifica-ciones terapéuticas para optimizar los resultados.</p><p class="elsevierStyleSimplePara elsevierViewall">Presentamos un método de aplicación práctica en casos en que se asista a resultados insuficientes de la ventilación. La detección de fugas bajo tratamiento ofrece la posibilidad de establecer la causa probable del fracaso, comprender el mecanismo fisiopatológico potencialmente responsable e inter-venir en consecuencia.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Heather S, Simmonds A, Ward S. Problem solving in acute NIPPV. In: Simmonds A, editor. Non invasive respiratory support. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 33 | 53 | 86 |
| 2024 September | 38 | 48 | 86 |
| 2024 August | 48 | 62 | 110 |
| 2024 July | 24 | 38 | 62 |
| 2024 June | 35 | 52 | 87 |
| 2024 May | 33 | 41 | 74 |
| 2024 April | 19 | 37 | 56 |
| 2024 March | 25 | 73 | 98 |
| 2024 February | 15 | 33 | 48 |
| 2023 October | 0 | 5 | 5 |
| 2023 March | 3 | 17 | 20 |
| 2023 February | 13 | 52 | 65 |
| 2023 January | 18 | 89 | 107 |
| 2022 December | 16 | 77 | 93 |
| 2022 November | 15 | 61 | 76 |
| 2022 October | 21 | 67 | 88 |
| 2022 September | 14 | 32 | 46 |
| 2022 August | 15 | 84 | 99 |
| 2022 July | 24 | 72 | 96 |
| 2022 June | 14 | 64 | 78 |
| 2022 May | 15 | 55 | 70 |
| 2022 April | 14 | 62 | 76 |
| 2022 March | 18 | 103 | 121 |
| 2022 February | 15 | 90 | 105 |
| 2022 January | 18 | 100 | 118 |
| 2021 December | 19 | 51 | 70 |
| 2021 November | 16 | 52 | 68 |
| 2021 October | 21 | 74 | 95 |
| 2021 September | 13 | 57 | 70 |
| 2021 August | 13 | 41 | 54 |
| 2021 July | 14 | 40 | 54 |
| 2021 June | 10 | 74 | 84 |
| 2021 May | 14 | 51 | 65 |
| 2021 April | 13 | 102 | 115 |
| 2021 March | 20 | 43 | 63 |
| 2021 February | 9 | 35 | 44 |
| 2021 January | 8 | 27 | 35 |
| 2020 December | 5 | 24 | 29 |
| 2020 November | 6 | 48 | 54 |
| 2020 October | 7 | 30 | 37 |
| 2020 September | 8 | 26 | 34 |
| 2020 August | 10 | 33 | 43 |
| 2020 July | 10 | 23 | 33 |
| 2020 June | 4 | 26 | 30 |
| 2020 May | 10 | 40 | 50 |
| 2020 April | 13 | 40 | 53 |
| 2020 March | 13 | 22 | 35 |
| 2020 February | 12 | 26 | 38 |
| 2020 January | 19 | 30 | 49 |
| 2019 December | 26 | 33 | 59 |
| 2019 November | 9 | 42 | 51 |
| 2019 October | 6 | 34 | 40 |
| 2019 September | 24 | 30 | 54 |
| 2019 August | 31 | 36 | 67 |
| 2019 July | 59 | 38 | 97 |
| 2019 June | 47 | 26 | 73 |
| 2019 May | 27 | 54 | 81 |
| 2019 April | 63 | 70 | 133 |
| 2019 March | 26 | 46 | 72 |
| 2019 February | 16 | 31 | 47 |
| 2019 January | 12 | 36 | 48 |
| 2018 December | 14 | 68 | 82 |
| 2018 November | 17 | 42 | 59 |
| 2018 October | 25 | 54 | 79 |
| 2018 September | 18 | 76 | 94 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 19 | 5 | 24 |
| 2018 March | 18 | 4 | 22 |
| 2018 February | 7 | 6 | 13 |
| 2018 January | 3 | 9 | 12 |
| 2017 December | 3 | 17 | 20 |
| 2017 November | 3 | 30 | 33 |
| 2017 October | 4 | 39 | 43 |
| 2017 September | 8 | 24 | 32 |
| 2017 August | 34 | 22 | 56 |
| 2017 July | 23 | 3 | 26 |
| 2017 June | 38 | 8 | 46 |
| 2017 May | 28 | 9 | 37 |
| 2017 April | 38 | 4 | 42 |
| 2017 March | 17 | 6 | 23 |
| 2017 February | 13 | 4 | 17 |
| 2017 January | 10 | 3 | 13 |
| 2016 December | 15 | 5 | 20 |
| 2016 November | 13 | 10 | 23 |
| 2016 October | 17 | 10 | 27 |
| 2016 September | 15 | 15 | 30 |
| 2016 August | 7 | 3 | 10 |
| 2016 July | 5 | 0 | 5 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 94 | 1 | 95 |
| 2015 September | 100 | 19 | 119 |
| 2015 August | 102 | 9 | 111 |
| 2015 July | 132 | 9 | 141 |
| 2015 June | 65 | 7 | 72 |
| 2015 May | 70 | 8 | 78 |
| 2015 April | 76 | 10 | 86 |
| 2015 March | 83 | 10 | 93 |
| 2015 February | 81 | 7 | 88 |
| 2015 January | 70 | 7 | 77 |
| 2014 December | 83 | 4 | 87 |
| 2014 November | 82 | 7 | 89 |
| 2014 October | 120 | 7 | 127 |
| 2014 September | 75 | 13 | 88 |
| 2014 August | 74 | 9 | 83 |
| 2014 July | 68 | 7 | 75 |
| 2014 June | 70 | 9 | 79 |
| 2014 May | 97 | 10 | 107 |
| 2014 April | 75 | 7 | 82 |
| 2014 March | 95 | 10 | 105 |
| 2014 February | 79 | 11 | 90 |
| 2014 January | 73 | 7 | 80 |
| 2013 December | 63 | 6 | 69 |
| 2013 November | 50 | 10 | 60 |
| 2013 October | 55 | 12 | 67 |
| 2013 September | 61 | 12 | 73 |
| 2013 August | 45 | 5 | 50 |
| 2013 July | 53 | 17 | 70 |
| 2013 June | 55 | 10 | 65 |
| 2013 May | 45 | 12 | 57 |
| 2013 April | 37 | 7 | 44 |
| 2013 March | 13 | 3 | 16 |
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