What does this research mean for the field?

Portable home ventilators using volume-targeted pressure ventilation consistently under-deliver target tidal volumes in pediatric ranges, with accuracy deteriorating significantly in the presence of high intentional leaks. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the accuracy of portable ventilators in maintaining target tidal volume amidst intentional leaks in pediatric settings.

May 20, 2026

A59-01 Testing Accuracy of Volume-Targeted Pressure Ventilation in Pediatric-Range Tidal Volumes: A Bench Study of Single Limb Circuit Home Ventilators With Intentional Leaks

Key Points

This study aims to evaluate the accuracy of portable ventilators in maintaining target tidal volume amidst intentional leaks in pediatric settings.
Three ventilators tested on a 0.5 L lung simulating pediatric mechanics.
Each device operated in volume-targeted pressure mode with a target tidal volume of 80 mL and adjusted for two leak levels.
Expiratory tidal volume was measured and analyzed across 10 stable breaths for accuracy and precision.
Under low-leak conditions, mean tidal volumes were below target: Vivo45 (69 mL), EV300 (60 mL), VOCSN (67 mL).
Under high-leak conditions, volumes decreased further: Vivo45 (57 mL), EV300 (50 mL), VOCSN (47 mL), indicating significant deviations of 29-41%.
Ventilator performance varied, with Vivo45 showing the best stability and VOCSN the largest loss in tidal volume under high leaks.

Abstract

Abstract Rationale Volume-targeted pressure ventilation (VT-PV) is increasingly incorporated into home ventilators to ensure a minimal tidal volume (TV) by automatically adjusting inspiratory pressure for goal TV. While adult data demonstrate configuration-dependent accuracy during unintentional leaks, a very limited number of studies have been conducted in the pediatric range, where smaller TV and higher leak-to-TV ratios may amplify algorithmic error. We aimed to quantify the ability of portable ventilators to maintain a certain target TV under controlled low and high intentional leaks with a single-limb passive circuit. Methods Three commercially available portable ventilators were connected to a 0.5 L test lung configured for pediatric mechanics. Each device operated in volume target pressure mode with a target TV of 80 mL, PEEP = 8 cmH2O, PIP min/max:15/30 cmH2O, Respiratory Rate: 20/min, inspiratory time of 0.7 s. Low and high intentional leaks were set by using two different exhalation valves. Expiratory tidal volume (VTe) was measured by a Fleisch pneumotachograph and integrated flow analysis. For each condition, 10 consecutive stable breaths were analyzed. Accuracy was expressed as absolute and percent deviation from the 80 mL target; precision as coefficient of variation (CV %). Results Six test conditions (three ventilators, two leak levels) were analyzed (See Figure 1 below). Under low-leak conditions, mean VTe was 69 mL (Vivo45), 60 mL (EV300), and 67 mL (VOCSN)—each below the 80 mL target by 14 - 25 %. During high-leak conditions, VTe further decreased to 57 mL, 50 mL, and 47 mL, corresponding to − 29 - 41 % deviation from the target. Across all devices, peak inspiratory pressure declined as leak increased, indicating an artificially high VTe estimation by the ventilator in the presence of a higher leak. Figure 1. Mean VTe by Device and Leak Group Conclusions Across all tested conditions, the ventilators under-delivered the target tidal volume, with the Vivo45 demonstrating the greatest stability and the VOCSN exhibiting the largest proportional loss. High leak levels consistently reduced VTe accuracy, underscoring algorithm-specific limitations in leak compensation. Overall, most single-limb passive circuit ventilators-maintained target VTe under low-leak conditions but deviated substantially with higher leaks. These findings emphasize the need to understand circuit design and leak-compensation algorithms when applying volume-targeted modes in pediatric patients with small tidal volumes. Further studies incorporating spontaneous efforts and dynamic leak variations are warranted to guide clinical application. This abstract is funded by: None

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