{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:48:07Z","timestamp":1784684887218,"version":"3.55.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T00:00:00Z","timestamp":1553558400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2019,7]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Noninvasive ventilation (NIV) is used to treat respiratory failure because it reduces the risks of endotracheal intubation and postextubation respiratory failure. A wide range of different interfaces is available, but concerns exist about rebreathing. This study evaluated a total face mask with a 2-limb ventilation circuit and separate access for inflow and outflow gas, which was developed to reduce rebreathing.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n In a bench test, a standard total face mask (with a single connector to the ventilation circuit) and the modified total face mask were applied to a mannequin connected to an active breathing simulator. A known CO\n 2<\/jats:sub>\n flow (V\u0307\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n ) was delivered to the mannequin's trachea. We tested the following settings: CPAP with the mechanical PEEP valve set at 8 cm H\n 2<\/jats:sub>\n O (with 60 and 90 L\/min continuous flow) and pressure support of 6 and 12 cm H\n 2<\/jats:sub>\n O (with 2 and 15 L\/min bias flow). The settings were tested at simulated breathing frequencies of 15 and 30 breaths\/min and with V\u0307\n \n CO\n 2<\/jats:sub>\n <\/jats:sub>\n of 200 and 300 mL\/min. The active simulator generated a tidal volume of 500 mL. Airway pressure, air flow, CO\n 2<\/jats:sub>\n concentration, and CO\n 2<\/jats:sub>\n flow as the product of air flow and CO\n 2<\/jats:sub>\n were recorded.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The mean volume of CO\n 2<\/jats:sub>\n rebreathed and the minimum CO\n 2<\/jats:sub>\n inspiratory concentration were significantly lower with the modified mask than with the standard mask. The 15 L\/min bias flow significantly decreased rebreathing with the DiMax0 mask, whereas it had no effect with the traditional mask.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n A face mask with a two-limb ventilation circuit and separate access for inflow and outflow gas reduces rebreathing during NIV. The addition of bias flow enhances this effect. Further studies are required to verify the clinical relevance.<\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.06269","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T16:21:58Z","timestamp":1553617318000},"page":"793-800","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Effect of Face Mask Design and Bias Flow on Rebreathing During Noninvasive Ventilation"],"prefix":"10.1177","volume":"64","author":[{"given":"Davide","family":"Signori","sequence":"first","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Bellani","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy."},{"name":"Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Calcinati","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Grassi","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy."},{"name":"Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Patroniti","sequence":"additional","affiliation":[{"name":"Department of Surgical and Integrated Diagnostical Science, University of Genoa, San Martino Hospital, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Foti","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy."},{"name":"Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00143507"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60496-7"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02426-2016"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2706"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199509283331301"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.151.6.7767523"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199710000-00018"},{"issue":"1","key":"e_1_3_2_9_2","first-page":"837","article-title":"Noninvasive ventilation in acute respiratory failure","volume":"9","author":"Mas A","year":"2014","unstructured":"Mas A, , Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis, 2014; 9(1):837\u2013852.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.4.2006027"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.109.1.179"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199408000-00009"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000142577.63316.C0"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.3.772"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.106.4.1109"},{"issue":"5","key":"e_1_3_2_16_2","first-page":"526","article-title":"Non-invasive ventilation: evaluation of CO2 washout by intentional leaking in three recent oronasal masks. A pilot study","volume":"81","author":"M\u00e9drinal C","year":"2015","unstructured":"M\u00e9drinal C, , Prieur G, , Contal O, , Villiot-Danger E, , Doyle C, , Reychler G, et al. Non-invasive ventilation: evaluation of CO2 washout by intentional leaking in three recent oronasal masks. A pilot study. Minerva Anestesiol, 2015; 81(5):526\u2013532.","journal-title":"Minerva Anestesiol"},{"issue":"10","key":"e_1_3_2_17_2","first-page":"1154","article-title":"Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency","volume":"78","author":"Pisani L","year":"2012","unstructured":"Pisani L, , Carlucci A, , Nava S. Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency. Minerva Anestesiol, 2012; 78(10):1154\u20131161.","journal-title":"Minerva Anestesiol"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.6338"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-003-1931-8"},{"key":"e_1_3_2_20_2","first-page":"240","volume-title":"Noninvasive Positive Pressure Ventilation: Principles and Applications","author":"Hill NS","year":"2001","unstructured":"Hill NS. Problems, remedies, and strategies to optimize the success of noninvasive ventilation. In: Noninvasive Positive Pressure Ventilation: Principles and Applications. 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