Detection of Simulated Pediatric Breathing by CPAP/NIV Devices

BACKGROUND: Home CPAP and noninvasive ventilation (NIV) are increasingly used in children. An appropriate choice of the CPAP/NIV device, according to the manufacturer recommendations, should guarantee accurate data collection software. However, not all devices display accurate patient data. We hypothesized that the detection of patient breathing may be expressed as a minimal tidal volume (V_Tmin) rather than a minimal weight. The aim of the study was to estimate the V_Tmin detected by home ventilators when set on CPAP.

METHODS: Twelve level I–III devices were analyzed using a bench test. Pediatric profiles were simulated with increasing V_T values to determine the V_Tmin that the ventilator may detect. The duration of CPAP use and the presence/absence of waveform tracings on the built-in software were also gathered.

RESULTS: V_Tmin varied according to the device, ranging from 16–84 mL, independent of level category. The duration of CPAP use was underestimated in all level I devices, which were either not able to display any waveform or only intermittently, until V_Tmin was reached. The duration of CPAP use was overestimated for the level II and III devices, with the display of different waveforms according to the device as soon as the device was switched on.

CONCLUSIONS: Based on the V_Tmin detected, some level I and II devices may be suitable for infants. A careful testing of the device should be done at CPAP initiation, with a review of data generated from ventilator software.