TY - JOUR T1 - A comparison of leak compensation in acute care ventilators during non-invasive and invasive ventilation; a lung model study JF - Respiratory Care DO - 10.4187/respcare.02466 SP - respcare.02466 AU - Jun Oto AU - Christopher T. Chenelle AU - Andrew D. Marchese AU - Robert M Kacmarek Y1 - 2013/05/21 UR - http://rc.rcjournal.com/content/early/2013/05/21/respcare.02466.abstract N2 - Background: Although leak compensation has been widely introduced to acute care ventilators to improve patient-ventilator synchronization in the presence of system leaks, there is no data on these ventilators ability to prevent triggering and cycling asynchrony. The goal of this study was to evaluate the ability of leak compensation in acute care ventilators during invasive and non-invasive ventilation (NIV). Methods: Using a lung simulator, the impact of system leaks was compared on 7 ICU ventilators and 1 dedicated NIV ventilator during triggering and cycling at two respiratory mechanics (COPD and ARDS models) settings, various modes of ventilation (NIV mode: pressure support ventilation; and invasive mode: pressure support and pressure assist/control), and two PEEP levels (5, and 10 cmH2O). Leak levels used were up to 35–36 L/min in NIV mode and 26–27 L/min in invasive mode. Results: Although all of the ventilators were able to synchronize with the simulator at baseline, only 4 of the 8 ventilators synchronized to all leaks in NIV and 2 of 8 ventilators in invasive ventilation. The number of breaths to synchronization was higher in increasing than decreasing leak. In the COPD model, miss-triggering occurred more frequently and required a longer time to stabilized tidal volumes than in the ARDS model. The PB840 required fewer breaths to synchronize in both invasive and NIV modes compared with the other ventilators (p < 0.001). Conclusions: Leak compensation in invasive and NIV modes has wide variations between ventilators. The PB840 and the V60 were the only ventilators to acclimate to all leaks but there were differences in performance between these two ventilators. It is not clear if these differences have clinical significance. ER -