title: Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study.
abstract: BACKGROUND
  Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently.
  
  
  METHODS
  Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (VT) before and after the change in leak was assessed.
  
  
  RESULTS
  The differences in delivered VTbetween before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline VTwas ≥10% greater than set VTduring PC-CSV, and delivered VTmarkedly changed with leak. The Avea demonstrated persistent high VTin all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV.
  
  
  CONCLUSIONS
  The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted VT. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.
authors.affiliation: Department of Respiratory Care.|Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Taiga
authors.initials: T
authors.lastname: Itagaki
authors.affiliation: Department of Respiratory Care.
authors.forename: Desmond J
authors.initials: DJ
authors.lastname: Bennett
authors.affiliation: Department of Respiratory Care.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chenelle
authors.affiliation: Department of Respiratory Care.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fisher
authors.affiliation: Department of Respiratory Care rkacmarek@mgh.harvard.edu.|Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D003198:Computer Simulation; D004868:Equipment Failure; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D008168:Lung / Q000502:physiology*; D008348:Manikins; D008954:Models, Biological; D012121:Respiration, Artificial / Q000295:instrumentation*; D013990:Tidal Volume; D012122:Ventilators, Mechanical
keywords: acute care ventilator; leak compensation; mechanical ventilation; neonates; patient-ventilator interaction; volume-targeted ventilation