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Copyright ©ERS Journals Ltd 2001
Leak compensation in positive pressure ventilators: a lung model study
a Mt. Sinai Hospital, University of Toronto, Toronto, Canada, b Memorial Hospital of Rhode Island and c Rhode Island Hospital and Brown University School of Medicine, Providence, RI, USA
CORRESPONDENCE: N.S. Hill, Division of Pulmonary, Sleep, and Critical Care Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. Fax: 1 4014446665
Keywords: mask ventilation, mechanical ventilators, noninvasive ventilation, portable ventilators
Received: September 30, 1999
Accepted August 21, 2000
Leak compensating abilities of six different positive pressure ventilators
commonly used to deliver noninvasive positive pressure ventilation, including
the bilevel positive airway pressure (BiPAP) S/T-D and
Quantum (Respironics Inc, Murrysville, PA, USA), 335 and O'NYX (Mallinckrodt
Inc, St Louis, MO, USA), PLV 102 (Respironics), and Siemens
Servo 900C (Siemens Inc, Danvers, MA, USA).
Using a test lung model, compensatory capabilities of the ventilators were
tested for smaller and larger leaks using the assist/control or timed
modes. Back-up rate was 20·min–1, inspiratory
pressure was 18 cmH2O, and expiratory pressure was 5 cmH2O.
It was found that even in the absence of air leaking, delivered tidal volume
differed substantially between the ventilators during use of pressure-targeted
modes, depending on inspiratory flows, inaccuracies in set versus
delivered pressures, and inspiratory duration. Also during pressure-targeted
ventilation, increasing the tI/ttot up to, but not beyond, 0.5 improved compensation by lengthening inspiratory
duration, whereas use of a sensitive flow trigger setting tended to cause
autocycling during leaking, interfering with compensation. Leaking interfered
with cycling of the BiPAP S/T, inverting the I:E ratio, shortening
expiratory time, and reducing delivered tidal volume. Volume-targeted
modes achieved limited compensation for small air leaks, but compensated poorly
for large leaks.
To conclude, leak-compensating capabilities differ markedly between
ventilators but pressure-targeted ventilators are preferred for noninvasive
positive pressure ventilation in patients with substantial air leaking. Adequate
inspiratory flows and durations should be used, triggering sensitivity should
be adjusted to prevent autocycling, and a mechanism should be available to
limit inspiratory time and avoid I:E ratio inversion.
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