A comparison of leak compensation during pediatric noninvasive ventilation: A lung model study

Abstract

BACKGROUND: Ventilators used for noninvasive ventilation (NIV) must be able to synchronize in the presence of system leaks. We compared the ability of 7 ICU ventilators and 3 dedicated NIV ventilators to compensate for leaks during pediatric NIV. METHODS: Using a lung simulator, we compared the Maquet Servo-i, Dräger V500, Dräger Carina, Covidien PB840, Respironics V60, Respironics Vision, GE Healthcare/Engström Carestation, CareFusion Avea, Hamilton C3, and Hamilton G5 during increasing (n = 6) and decreasing leaks (n = 6). With a lung simulator we tested 4 leak levels (baseline [BL] 2-3 L/min, L1 5-6 L/min, L2 9-10 L/min, and L3 19-20 L/min); 3 patient weights (10, 20, and 30 kg); and 3 lung mechanics scenarios (normal, obstructive, and restrictive). The ventilator settings were NIV mode, pressure support of 10 cm H2O, and PEEP of 5 cm H2O. The synchronization rate (synchronized cycles/total simulated respirations) was recorded for each ventilator and each leak scenario. Synchronization was defined as triggering without auto-triggering, miss-triggering, delayed cycling, or premature cycling. RESULTS: The mean synchronization rate across all ventilators was 68 ± 27% (range 23-96%) and marked differences existed between the ventilators (P