PT - JOURNAL ARTICLE AU - Jun Oto AU - Christopher T. Chenelle AU - Andrew D. Marchese AU - Robert M Kacmarek TI - A comparison of leak compensation during pediatric non-invasive positive pressure ventilation; a lung model study AID - 10.4187/respcare.02616 DP - 2013 Jul 02 TA - Respiratory Care PG - respcare.02616 4099 - http://rc.rcjournal.com/content/early/2013/07/02/respcare.02616.short 4100 - http://rc.rcjournal.com/content/early/2013/07/02/respcare.02616.full AB - Background: Ventilators used for non-invasive positive pressure 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. Method: Using a lung simulator, the Maquet Servo-i, the Dräger V500, the Dräger Carina, the Covidien PB840, the Respironics V60, the Respironics Vision, the General Electric Engström Carestation, the CareFusion Avea, the Hamilton C3 and the Hamilton G5 were compared during increasing (n=6) and decreasing leaks (n=6). Leak levels used were: BL (baseline of 2–3 L/min), L1 (5–6 L/min), L2 (9–10 L/min) and L3 (19–20 L/min). Three patient sizes (10, 20, and 30 kg) with three different lung mechanics (normal, obstructive, and restrictive models) were simulated by the ASL5000 lung simulator. Ventilator settings were non-invasive ventilation mode, pressure support 10 cmH2O and PEEP 5 cmH2O. The rate of synchronization (synchronized cycles/total simulated respirations) was recorded for each ventilator for each leak scenario. Synchronization was defined as triggering without auto-triggering, miss-triggering, delayed cycling or premature cycling. Results: The mean rate of synchronization across all ventilators was 68±27% (range: 23%–96%) and marked differences existed between ventilators (p < 0.001). Significant differences in the rate of synchronization were observed between the 10 kg (mean: 57±30%; range: 17%–93%), the 20 kg (69±30%; 25%–98%) and the 30 kg models (77±22%; 28%–97%) (p < 0.001). The synchronization rate for the obstructive model (60±30%; 9%–94%) was significantly different from the normal model (71±29%; 18%–98%) and the restrictive model (72±28%; 23%–98%) (p < 0.001). The PB840 and the C3 had synchronization rates over 90% with all body weights, all lung mechanic profiles and all leak levels. Conclusions: Leak compensation in NPPV for pediatric use can partially compensate for leaks, but varies widely among ventilators, patient weights, and lung mechanics.