We thank AnnMarie Preece for her comments on our article,1which help us to clarify the description of some specifications of the Avance ventilator. Indeed, the inspiratory flow triggering on this ventilator is selectable from 0.2 to 10 l/min. However, this point, like the other comments from Ms. Preece, does not modify the reported results of the article about the Avance ventilator. In table 1 of our article, which reported the main characteristics of anesthesia and intensive care unit ventilators tested, some characteristics of pressure-support ventilation in the Avance ventilator should be corrected as follows: The pressurization phase in pressure-support ventilation allows a slope adjustable from 0 to 500 ms, and the expiratory trigger is adjustable from 5% to 50% of peak inspiratory flow. As stated in the article, the Fabius and Primus are “piston ventilators,” which use an electric motor to compress gas in the breathing circuit, creating the driving force for mechanical insufflation to proceed. However, the Avance is not a piston ventilator as stated in the article, but is one of the last generation of “bellow ventilators” which uses a microprocessor-driven flow control valve system like all major intensive care unit ventilators combined with a dynamic regulation of the internal compliance of the ventilator. These features may explain in part why these more recent anesthesia ventilators have comparable performance to modern intensive care unit ventilators.

As stated in the editorial by Hossam Tantawy and Jan Ehrenwerth,2this study permitted an important addition to the literature because it shows that technology improvements in traditional intensive care unit ventilators can be transferred to the operating room and the anesthesiologist must understand the pressure-support ventilation indications and limitations, know how to implement it properly, and determine its cost effectiveness.

*Hôpital Saint Eloi, Montpellier, France. s-jaber@chu-montpellier.fr

Jaber S, Tassaux D, Sebbane M, Pouzeratte Y, Battisti A, Capdevila X, Eledjam JJ, Jolliet P: Performance characteristics of five new anesthesia ventilators and four intensive care ventilators in pressure-support mode: A comparative bench study. Anesthesiology 2006; 105:944–52
Tantawy H, Ehrenwerth J: Pressure-support ventilation in the operating room: Do we need it? Anesthesiology 2006; 105:872–3