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Is volume assured ventilation always able to compensate volume loss in presence of leaks

Background: Volume assured (V TG ) ventilation is a pressure targeted mode aimed to guarantee a target tidal volume (Vt) by varying the inspiratory pressure between two preset pressure values. V TG ventilation has been used to correct sleep-related periodic hypoventilations during noninvasive ventilation (NIV). However, in this setting the likelihood of non-intentional leaks (NIL) may be high. Aim and Methods : In a bench study we wanted to assess the V TG NIL compensation algorithm in three turbine driven ventilators designed to set a V TG either with an EVC or with an ILC (Vivo50, Breas; PB560, Covidien; Ventimotion, Weimann). All ventilators were tested in random order using a lung simulator (Ingmar, ASL5000) in V TG Pressure Control mode with both the ILC and the EVC at three level of leaks (15, 27 and 37 l/min) and at three different conditions of respiratory mechanics: normal, obstructive and restrictive. Results : All the ventilators in the ILC configuration were able to maintain the V TG in all simulated conditions; conversely, during all simulated leak conditions when the EVC was used a significant fall both in Vt and inspiratory pressure compared to the baseline value was observed. Conclusions : All single circuit ventilators tested in ILC configuration were able to compensate the volume loss and to ensure the preset V TG in all leak conditions but failed to ensure the V TG when the EVC was used.