Volume-Targeted Ventilation in the Neonate: Benchmarking Ventilators on an Active Lung Model

Area of Science:

• Neonatal critical care
• Mechanical ventilation
• Respiratory physiology

Background:

• Mechanically ventilated neonates often experience inconsistent ventilation when switching between ventilator models, even with identical settings.
• This variability raises concerns about patient safety and the efficacy of mechanical ventilation protocols.
• Understanding the performance range of neonatal ventilators is crucial for optimizing patient care.

Purpose of the Study:

• To quantify the output variability among ten different neonatal ventilator models.
• To assess ventilator performance under simulated neonatal breathing conditions.
• To determine the range of tidal volume delivery across various patient sizes and respiratory patterns.

Main Methods:

• A comparative benchmarking test was conducted using ten neonatal ventilators.
• An active neonatal lung model simulated three patient weights (500g, 1500g, 3500g) and three breathing modes (passive, constant active, variable active).
• Ventilators were set to flow-triggered, synchronized, volume-targeted, pressure-controlled, continuous mandatory ventilation.

Main Results:

• Ventilators delivered tidal volumes ranging from 86% to 126% of the target across all conditions.
• Significant deviations were observed, particularly in the 500g simulated patient with constant active breathing, where the highest output was 147% of the lowest.
• Performance varied based on patient weight, breathing mode, and ventilator model.

Conclusions:

• All tested neonatal ventilators exhibited significant variability in volume output and ventilation regulation.
• These discrepancies are influenced by ventilation type, respiratory effort, and patient characteristics.
• Universal tidal volume targets for neonatal mechanical ventilation require model-specific adjustments due to observed performance differences.