In this study, we used the TNI softflow 50 device (TNI medical AG, Wuerzburg, Germany). NHF was applied using nasal prongs with different bore outlets (TNI medical AG, Wuerzburg, Germany) in order to apply the intended elevated flow rates. Small (ID 3.2 mm), medium (3.9 mm), and large (ID 5 mm) sizes of nasal prongs were compared as part of the study. nBiPAP and nCPAP were both applied using a nose mask (BiPAP Synchrony, Philips Respironics, Andover, MN, USA).
Bipap synchrony
Manufactured by Philips
Sourced in United States
The BiPAP Synchrony is a bi-level positive airway pressure (BiPAP) device designed to provide non-invasive ventilatory support. It delivers adjustable levels of inspiratory and expiratory positive airway pressure to assist with breathing. The device is intended for use in a hospital or clinical setting by healthcare professionals.
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Lab products found in correlation
6 protocols using bipap synchrony
1
Evaluating Nasal High-Flow Devices
2
High-Flow Nasal Therapy vs. NIV Comparison
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Enrolled patients received 30 min of HFNT or clinically set NIV in random order determined by a sealed opaque envelope. Physiological measurements were taken at baseline and at 25 min of each session of HFNT and NIV. Baseline oxygen settings were applied during a 10-minute washout period following the first device and at the end of the study.
HFNT (AIRVO-2®, Fisher & Paykel, Auckland, New Zealand) was set to a maximal inspiratory flow rate of 55 L/min as tolerated by the patient. FiO2 was adjusted to achieve a SpO2 of at least 92% and temperature at 37 °C or 34 °C according to patient’s individual preference.
Three NIV systems were used for the study depending on availability at enrollment (ResMed Stellar 150, ResMed VPAP III ST-A, ResMed Corp., California, USA or Respironics BiPAP Synchrony Respironics, Pennsylvania, USA). Two full face masks were available and were chosen based on patient preference: ResMed Hospital Full Face Mask (California, USA) and Fisher & Paykel Hospital Full Face Mask (Auckland, New Zealand). FiO2 was adjusted to achieve a SpO2 of at least 92%. NIV settings were those previously adjusted by the respiratory therapy team, based on oxygenation, arterial blood gases and patient tolerance; they were not modified for the purpose of the study and were kept unaltered during the study period.
HFNT (AIRVO-2®, Fisher & Paykel, Auckland, New Zealand) was set to a maximal inspiratory flow rate of 55 L/min as tolerated by the patient. FiO2 was adjusted to achieve a SpO2 of at least 92% and temperature at 37 °C or 34 °C according to patient’s individual preference.
Three NIV systems were used for the study depending on availability at enrollment (ResMed Stellar 150, ResMed VPAP III ST-A, ResMed Corp., California, USA or Respironics BiPAP Synchrony Respironics, Pennsylvania, USA). Two full face masks were available and were chosen based on patient preference: ResMed Hospital Full Face Mask (California, USA) and Fisher & Paykel Hospital Full Face Mask (Auckland, New Zealand). FiO2 was adjusted to achieve a SpO2 of at least 92%. NIV settings were those previously adjusted by the respiratory therapy team, based on oxygenation, arterial blood gases and patient tolerance; they were not modified for the purpose of the study and were kept unaltered during the study period.
3
Comparing Nasal High-Flow and BiPAP/CPAP
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In this study, we used the TNI softflow 50 device (TNI medical AG, Wuerzburg, Germany). NHF was applied using nasal prongs with different bore outlets (TNI medical AG) in order to apply the intended elevated flow rates. Small, medium, and large sizes of nasal prongs were compared as a part of the study. The nasal bilevel positive airway pressure (nBiPAP) and nasal continuous positive airway pressure (nCPAP) were applied using a nose mask (BiPAP Synchrony; Philips Respironics, Andover, MA, USA) because of faster adaptation during measurement. The aim was to illustrate different modes of action between NHF and nCPAP/nBiPAP. Therefore, we applied lower pressures than used in daily practice.
4
Bilevel NPPV Protocol for Respiratory Support
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Bilevel NPPV was delivered via nasal or oronasal mask using one of the following ventilators: (1) VPAP ST series (VPAP II ST, VPAP II ST-A, or VPAP III ST-A; ResMed, Sydney, Australia), (2) VS SERENA (Res Med, Sydney, Australia), or (3) BiPAP Synchrony series (BiPAP Synchrony or BiPAP Harmony; Respironics, Inc., Murrysville, PA). The commercial masks were sized appropriately to each patient's nose or face. In all cases, the ventilator was initially set to spontaneous/timed (S/T) mode. We start NPPV with low inspiratory pressures (8–10 cm H2O) and gradually titrate upward as tolerated by the patient as previously reported[1 (link)] with an EPAP in the range of 2–5 cm H2O, with a backup respiratory frequency (fR) below the rate of awake spontaneous breathing. We did not set up any target minute ventilation or tidal volume on the initiation of NPPV. Oxygen was supplied from the mask's side port at a flow rate needed to achieve a target SpO2 of 90%. Heated humidifiers were used for all patients.
5
High-Intensity Nocturnal NIV Protocol
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All patients were initiated on NIV by the same registered nurse according to a standardized high-intensity protocol. NIV was supplied through a pressure cycled ventilator, applying both an inspiratory and expiratory positive airway pressure, with a backup respiratory rate (BiPAP Synchrony® and A30®, Respironics, Murrysville, PA, USA). The effectiveness of NIV during the night was observed by monitoring the transcutaneous PCO2 and O2 saturation (TOSCA® 500, Linde Medical Sensors AG, Basel, Switzerland). Supplementary oxygen was applied through the ventilator in regular amount. Monitoring of efficacy was done ambulatory using the TOSCA device.
6
Elective Initiation of Noninvasive Ventilation
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The majority of the patients started NIV in an elective setting. Patients had been admitted for diagnostic evaluation and NIV titration normally for 3-5 days. A mandatory back-up rate was always used and titration of inspiratory support and expiratory positive airway pressure were set with the aid of nocturnal monitoring with pulse oximeter, transcutaneous CO 2 and respiratory polygraphy. A further description of the ventilator titration algorithm is available in the Norwegian national guidelines for long term mechanical ventilation [38] . The included patients used the following mechanical ventilators: ResMed devices: VPAP III ST-A (n = 7), S8 VPAP IV ST (n = 20), S9 VPAP ST (n = 15), S9 VPAP ST-A (n = 5), Stellar 150 (n = 8) and Elisée 150 (n = 2). Philips Respironics devices: BIPAP AVAPS (n = 9) and BIPAP SYNCHRONY (n = 1).
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