RT Journal Article SR Electronic T1 A Comparison of Leak Compensation During Pediatric Noninvasive Ventilation: A Lung Model Study JF Respiratory Care FD American Association for Respiratory Care SP 241 OP 251 DO 10.4187/respcare.02616 VO 59 IS 2 A1 Jun Oto A1 Christopher T Chenelle A1 Andrew D Marchese A1 Robert M Kacmarek YR 2014 UL http://rc.rcjournal.com/content/59/2/241.abstract AB 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 < .001). Significant differences in synchronization rate were observed between the 10-kg model (mean 57 ± 30%, range 17–93%), the 20-kg model (69 ± 30%, 25–98%), and the 30-kg models (77 ± 22%, 28–97%) (P < .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 < .001). The PB840 and the C3 had synchronization rates over 90% overall across all body weights, all lung mechanic profiles, and all leak levels. CONCLUSIONS: Leak compensation in NIV for pediatric use can partially compensate for leaks, but varies widely among ventilators, patient weights, and lung mechanics.