title: Neonatal and adult ICU ventilators to provide ventilation in neonates, infants, and children: a bench model study.
abstract: BACKGROUND
  Using a bench test model, we investigated the hypothesis that neonatal and/or adult ventilators equipped with neonatal/pediatric modes currently do not reliably administer pressure support (PS) in neonatal or pediatric patient groups in either the absence or presence of air leaks.
  
  
  METHODS
  PS was evaluated in 4 neonatal and 6 adult ventilators using a bench model to evaluate triggering, pressurization, and cycling in both the absence and presence of leaks. Delivered tidal volumes were also assessed. Three patients were simulated: a preterm infant (resistance 100 cm H2O/L/s, compliance 2 mL/cm H2O, inspiratory time of the patient [TI] 400 ms, inspiratory effort 1 and 2 cm H2O), a full-term infant (resistance 50 cm H2O/L/s, compliance 5 mL/cm H2O, TI 500 ms, inspiratory effort 2 and 4 cm H2O), and a child (resistance 30 cm H2O/L/s, compliance 10 mL/cm H2O, TI 600 ms, inspiratory effort 5 and 10 cm H2O). Two PS levels were tested (10 and 15 cm H2O) with and without leaks and with and without the leak compensation algorithm activated.
  
  
  RESULTS
  Without leaks, only 2 neonatal ventilators and one adult ventilator had trigger delays under a given predefined acceptable limit (1/8 TI). Pressurization showed high variability between ventilators. Most ventilators showed TI in excess high enough to seriously impair patient-ventilator synchronization (> 50% of the TI of the subject). In some ventilators, leaks led to autotriggering and impairment of ventilation performance, but the influence of leaks was generally lower in neonatal ventilators. When a noninvasive ventilation algorithm was available, this was partially corrected. In general, tidal volume was calculated too low by the ventilators in the presence of leaks; the noninvasive ventilation algorithm was able to correct this difference in only 2 adult ventilators.
  
  
  CONCLUSIONS
  No ventilator performed equally well under all tested conditions for all explored parameters. However, neonatal ventilators tended to perform better in the presence of leaks. These findings emphasize the need to improve algorithms for assisted ventilation modes to better deal with situations of high airway resistance, low pulmonary compliance, and the presence of leaks.
authors.affiliation: Cardio-Respiratory Physiotherapy Unit, Hôpital de La Tour, Meyrin, Switzerland. Peritox, EA 4284-Unité Mixte I01, L'Institut National de l'Environnement Industriel et des Risques, Université de Picardie Jules Verne, Amiens, France. Adult Intensive Care Unit, University Hospital of Geneva, Geneva, Switzerland. laurence.vignaux@latour.ch.
authors.forename: Laurence
authors.initials: L
authors.lastname: Vignaux
authors.affiliation: Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.affiliation: Peritox, EA 4284-Unité Mixte I01, L'Institut National de l'Environnement Industriel et des Risques, Université de Picardie Jules Verne, Amiens, France. Pediatric Intensive Care Unit, University Hospital North, Amiens, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tourneux
authors.affiliation: Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jolliet
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rimensberger
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007362:Intensive Care Units; D008297:Male; D011175:Positive-Pressure Respiration; D015656:Respiratory Mechanics; D013673:Technology Assessment, Biomedical; D013990:Tidal Volume; D012122:Ventilators, Mechanical
keywords: artificial; equipment safety; intensive care units; mechanical ventilators; models; neonatal; pediatrics; respiration; ventilatory support