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Problem Urbanization, large dog populations and failed control efforts have contributed to continuing endemicity of dog-mediated rabies in KwaZulu-Natal province, South Africa. Approach From 2007 to 2014 we used a OneHealth approach to rabies prevention, involving both the human and animal health sectors. We implemented mass vaccination campaigns for dogs to control canine rabies, and strategies to improve rabies awareness and access to postexposure prophylaxis for people exposed to rabies. Local setting A rabies-endemic region, KwaZulu-Natal is one of the smallest and most populous South African provinces (estimated population 10 900 000). Canine rabies has persisted since its introduction in 1976, causing an average of 9.2 human rabies cases per annum in KwaZulu-Natal from 1976 to 2007, when the project started. Relevant changes Between 2007 and 2014, the numbers of dog vaccinations rose from 358 611 to 395 000 and human vaccines purchased increased form 100 046 to 156 996. Strategic dog vaccination successfully reduced rabies transmission within dog populations, reducing canine rabies cases from 473 in 2007 to 37 in 2014. Actions taken to reduce the incidence of canine rabies, increase public awareness of rabies and improve delivery of postexposure prophylaxis contributed to reaching zero human rabies cases in KwaZulu- Natal in 2014. Lessons learnt Starting small and scaling up enabled us to build strategies that fitted various local settings and to successfully apply a OneHealth approach. Important to the success of the project were employing competent, motivated staff, and providing resources, training and support for field workers. Probleme L'urbanisation, les importantes populations canines et les mesures de lutte inefncaces ont contribue a l'endemlcite persistante de la rage transmise par les chlens dans la province du KwaZulu-Natal, en Afrique du Sud. Approche De 2007 a 2014, nous avons applique l'approche <> pour la prevention de la rage, et mobilise les secteurs de la sante humalne et de la sante animale. Nous avons mene des campagnes de vaccination massive des chiens en vue de lutter contre la rage canine, et deploye des strategies pour mleux sensibiliser la population a la rage et ameliorer l'acces des personnes exposees a la rage a la prophylaxle post-exposition. Environnement local Le KwaZulu-Natal, ou la rage est endemique, est l'une des provinces d'Afrique du Sud les plus petites et les plus peuplees (population estimee a 10 900 000 habitants). La rage canine persiste depuis son apparition en 1976, ayant provoque en moyenne 9,2 cas de rage humaine par an au KwaZulu-Natal entre 1976 et 2007, annee qui a marque le lancement du projet. Changements significatifs Entre 2007 et 2014, le nombre de vaccinations pratiquees sur des chiens est passe de 358 611 a 395 000, tandis que le nombre de vaccins humains achetes est passe de 100 046 a 156 996. La vaccination strategique des chiens a permis de faire reculer la transmission de la rage au sein des populations canines, le nombre de cas de rage animale passant de 473 en 2007 a 37 en 2014. Les actions prises pour reduire l'incidence de la rage canine, sensibillser la population a la rage et ameliorer l'acces a la prophylaxle post-exposition ont permis qu'aucun cas de rage humaine ne soit declare au KwaZulu-Natal en 2014. Lecons tirees En demarrant nope projet sur une petite echelle, puis en lui donnant une ampleur accrue, nous avons pu elaborer des strategles adaptees aux differents contextes locaux et appllquer avec succes l'approche <>. Le succes du projet a repose en grande partie sur le recrutement de professionnels competents et motives, et la mise a disposition de ressources, de formations et d'un soutien pour les agents locaux. Problema La urbanizacion, las grandes poblaciones de perros y los esfuerzos fallidos de control han contribuido a la continuacion de la transmision de la rabia por perros en la provincia de KwaZulu-Natal, Sudafrica. Enfoque De 2007 a 2014, se utilizo un enfoque <> para la prevencion de la rabia, que involucraba a los sectores de salud humana y animal. Se implementaron campanas de-vacunacion masiva para perros para controlar la rabia canina, asi como estrategias para mejorar la concienciacion sobre la rabia y el acceso a la profilaxis posterior a la exposicion para las personas expuestas a la rabia. Marco regional Una region endemica de la rabia, KwaZulu-Natal es una de las provincias sudafricanas mas pequenasy pobladas (poblacion estimada en 10 900 000). La rabia canina ha persistido desde su aparicion en 1976, causando una media de 9,2 casos de rabia en humanos al ano en KwaZulu-Natal entre 1976 y 2007, cuando comenzo el proyecto. Cambios importantes Entre 2007 y 2014, el numero de vacunas administradas a perros aumento de 358 611 a 395 000, mientras que las vacunas humanas adquiridas aumentaron de 100 046 a 156 996. La vacunacion estrategica en los perros redujo con exito la transmision de la rabia en las poblaciones caninas, lo que redujo los casos de rabia animal de 473 en 2007 a 37 en 2014. Las medidas adoptadas para reducir la Incidencia de la rabia canina, aumentar la concienciacion publica sobre la rabia y mejorar el suministro de profilaxis posterior a la exposicion contribuyeron a que en KwaZulu-Natal no se dieran casos de rabia humana en 2014. Lecciones aprendidas Empezar a pequena escala y despues incrementar los esfuerzos permitio crear estrategias que se ajustasen a los diversos marcos regionales e implementar con exito un enfoque <>. Para que el proyecto tuviera exito, fue importante contar con personal competente y motivado, asi como ofrecer recursos, formacion y apoyo a los trabajadores de campo. [phrase omitted], Introduction Rabies is a fatal zoonotic disease, causing tens of thousands of human deaths each year. (1) Most human rabies cases worldwide are caused by dog bites (2) and are [...]

Rabies remains a significant problem throughout much of the developing world. An estimated 69 000 people die annually from exposure to rabies. Most of these deaths are the result of being bitten by a rabid dog. Mass vaccination campaigns targeting dogs have been implemented around the world in an attempt to control or eliminate canine rabies. We analysed the vaccination and cost data for a campaign in the KwaZulu-Natal province of South Africa; we found that the cost per dog vaccinated to be $6.61 for mass campaigns and $5.41 for local campaigns. We also estimated the cost of human post-exposure prophylaxis ( PEP). The cost of PEP is approximately $64.50 on average per patient, and $333 on average for the 9% of patients who receive RIG. We also found that the districts that vaccinated the most dogs per capita experienced the highest rates of human treatment and thus had the highest PEP costs. [ABSTRACT FROM AUTHOR]

Background: Mechanical insufflation-exsufflation (MI-E) devices are used to improve airway clearance in individuals with acute respiratory failure. Some MI-E devices measure cough peak flow (CPF) during MI-E to optimize pressure adjustments. The aim was to compare CPF and effective cough volume (ECV: volume expired/coughed > 3 L/s) measurements between 4 MI-E devices under simulated conditions of stable versus collapsed airway., Methods: Four MI-E devices were tested on the bench. Each device was connected via a standard circuit to a collapsible tube placed in an airtight chamber that was attached to a lung model with adjustable compliance and resistance. Pressure was measured upstream and downstream the collapsing tube; air flow was measured between the chamber and the lung model. Each device was tested in 2 conditions: collapse condition (0 cm H 2 O) and no-collapse condition (-70 cm H 2 O). For each condition, 6 combinations of inspiratory/expiratory pressures were applied. CPF was measured at the "mouth level" by the device built-in flow meter and at the "tracheal level" by a dedicated pneumotachograph. Comparisons were performed with non-parametric tests., Results: CPF values measured at the tracheal level and ECV values differed between devices for each inspiratory/expiratory pressure in the collapse and no-collapse conditions ( P < .001). CPF values were significantly lower at the tracheal level in the collapse as compared with the no-collapse condition ( P < .001 for each device), whereas they were higher at the mouth level ( P < .05) for 3 of the 4 devices., Conclusions: CPF values differed significantly across MI-E devices, highlighting limitation(s) of using only CPF values to determine cough effectiveness. In simulated of airway collapse, CPF increased at the mouth, whereas it decreased at the tracheal level., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2023 by Daedalus Enterprises.)

Background: Noninvasive ventilation (NIV) is the reference standard treatment for most situations of chronic respiratory failure. NIV settings must be titrated to both preserve upper-airway patency and control hypoventilation. Automatic adjustment of pressure support (PS) and expiratory positive airway pressure (EPAP) may facilitate the initiation and follow-up of domiciliary NIV. However, whether the automatic-adjustment algorithms embedded into current devices accurately detect, respond to, and score common sleep-related respiratory events remains unclear., Methods: A bench was set up to simulate central hypopnea (CH), central apnea (CA), obstructive hypopnea (OH), and obstructive apnea (OA). Four home ventilators were evaluated, with their dedicated modes for automatic PS and EPAP adjustment., Results: All 4 devices increased PS during CH, CA, and OH. However, PS adjustment varied widely in magnitude, with tidal volumes within 100 ± 20% of the target being provided by only 3 devices for CH, one for CA, and one for OH. Two devices increased EPAP for OH and 3 for OA, including one that also increased EPAP for CA. Only 2 devices scored residual hypopnea after simulated CA, and only one scored a residual event after OH. One device scored no event., Conclusions: Current NIV devices differed markedly in their responses to, and reporting of, standardized sleep-related respiratory events. Further improvements in embedded NIV algorithms are needed to allow more widespread out-of-laboratory initiation and follow-up of NIV., Competing Interests: Mr Delorme discloses relationships with Air Liquide Medical Systems, Breas Medical, ResMed, and L3 Medical. Dr Leotard discloses relationships Air Liquide Medical Systems. The remaining authors have disclosed no conflicts of interest., (Copyright © 2023 by Daedalus Enterprises.)

Objective: The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis., Material and Methods: Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices., Results: Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months., Conclusions: 3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics., Competing Interests: PMF is the CTO of BONE 3D (Paris). AMR, KL, and JPH are employees of ASV Santé (Genevilliers, France). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background and Objective: Around 25% of patients with neuro-muscular diseases (NMD) are treated by home noninvasive ventilation (NIV) through an oronasal mask. However, there is growing evidence that nasal masks require lower NIV pressures and result in fewer residual obstructive events. We hypothesized that nasal masks would improve efficacy and reduce side effects compared to oronasal masks in this population., Methods: open label, cross-over, randomized, study in 2 tertiary care hospitals. Patients with NMD treated by home NIV were randomized for one-week periods to nasal and oronasal interfaces respectively (cross-over). At the end of each period, nocturnal polygraphy (monitoring mouth opening) under NIV, synchronized with transcutaneous partial pressure in CO 2 (tcCO 2 ) was performed. Data were collected from the NIV built-in software and NIV side-effects were collected. Intention-to-treat and per protocol analyses were performed. The primary outcome was mean nocturnal SpO 2 . The secondary outcomes were: percentage of sleep with SpO 2 <90%, oxygen desaturation index (ODI), mean tcCO 2 , mean duration of mouth opening during sleep, level of non-intentional leaks and side-effects., Results: Thirty patients with NMD were included. There were no between-group differences for either the primary or secondary outcomes. Post hoc comparisons showed that changing between interfaces reduced NIV efficacy: mean nocturnal SpO 2 (p=0.04), ODI (p=0.01), mean tcCO2 (p=0.048), side-effects (p=0.008)., Conclusion: Nasal masks did not improve NIV efficacy or reduce side effects compared to oronasal masks in patients with NMD treated by home NIV. The efficacy of NIV is reduced during the transition to another interface, requiring close monitoring. Registration number: NCT03458507., (Copyright © 2020 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: With the current COVID-19 pandemic, concerns have raised regarding the risk for NIV to promote airborne transmission. In case of hospital admission, continuation of therapy in patients undergoing chronic NIV is necessary and several protective circuit configurations have been recommended to reduce the risk of aerosol dissemination. However, all these configurations increase instrumental dead space. We therefore designed this study to evaluate their effects on the tidal volume (VT E ) required to preserve stable end-tidal CO 2 partial pressure (P ET CO 2 ) with constant respiratory rate., Methods: A bench consisting of a test lung connected to an adult-sized mannequin head was set up. The model was ventilated through usual domiciliary configuration (single limb circuit with facial vented mask) which was used as reference. Then, five different circuit configurations including non-vented facial mask with viral/bacterial filter, modification of leak position, and change from single to double-limb circuit were evaluated. For each configuration, pressure support (PS) was gradually increased to reach reference P ET CO 2 . Resulting VT E was recorded as primary outcome., Results: Reference P ET CO 2 was 38(0) mmHg, with a PS set at 10 cmH 2 O, resulting in a VT E of 432(2) mL. Compared to reference, all the configurations evaluated required substantial increase in VT E to preserve alveolar ventilation, ranging from +79(2) to +216(1) mL., Conclusions: Modifications of NIV configurations in the context of COVID-19 pandemic result in substantial increase of instrumental dead space. Re-evaluation of treatment efficiency and settings is crucial whenever protective measures influencing NIV equipment are considered., (© 2021 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Adaptive servoventilation (ASV) is a recently developed ventilation mode designed to stabilize ventilation in patients with central sleep apnea and Cheyne-Stokes respiration. Alternatively, modes aiming to maintain average ventilation over several breaths, such as average volume-assured pressure support (AVAPS) and intelligent volume-assured pressure support (iVAPS), could be efficient during ventilation instability by reducing central events. These modes are available on a variety of devices. This bench evaluation studied the response of these different modes and devices to simulated transient hypoventilation events., Methods: Three home ventilation devices operating in ASV modes (AirCurve S10 VAuto, ResMed; DreamStation autoSV, Philips; Prisma CR, Löwenstein) and 2 ventilators with the AVAPS mode (DreamStation BiPAP, Philips; Lumis iVAPS, ResMed) were evaluated during transient central hypopnea/hypoventilation simulations characterized by a constant breathing frequency of 15 breaths/min and a progressive decrease of tidal volume (V T ) from 500 mL to 50 mL, in 18, 12, 9, and 6 breaths, respectively, followed by a progressive return to the baseline at the same rate., Results: The AirCurve S10 VAuto reacted to a V T decrease between 80% and 50% of baseline V T . DreamStation BiPAP and Prisma CR reacted when V T decreased to between 60% and 30% of baseline V T , whereas the AVAPS response to hypopnea occurred during the crescendo phase of hypopnea/hypoventilation V T . The iVAPS response was between that of the AirCurve S10 VAuto and the other ASV devices. Among the ASV devices, the minimum V T was higher with AirCurve S10 VAuto, followed by the Prisma CR and the DreamStation BiPAP. Minimum V T was not influenced by AVAPS and was improved by iVAPS without outperforming the AirCurve S10 VAuto. Maximum V T was increased by iVAPS, whereas ASV devices did not induce a significant V T overshoot., Conclusions: ASV devices improved central hypopnea/hypoventilation events without inducing hyperpnea events and therefore were better adapted than AVAPS and iVAPS devices, with notable differences in their responses to hypoventilation events., Competing Interests: The devices used in this study were donated by ASV Santé, which is a home care provider. The authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Objective: Only a few studies have addressed strategies to improve continuous positive airway pressure (CPAP) adherence in children with obstructive sleep apnea. The aim of our study was to assess the efficacy of a table based on token economy to improve CPAP adherence., Methods: A table was proposed to children nonadherent to CPAP (<3 h per night of CPAP use), eight days after CPAP initiation (D8). The child has to fill the table on a daily basis with green (I used my CPAP this night) or red (I did not use my CPAP) tokens. Objectives of CPAP use and rewards were decided between the child and their parents. An assessment of CPAP adherence was performed one month after initiation of table filling (M1) and compared to CPAP adherence at D8, and to data of adherent children., Results: Data of six nonadherent and nine adherent children were gathered (age 5 ± 5 vs. 5 ± 3 years, p = 0.953; apnea-hypopnea index 20 ± 15 vs. 25 ± 16 events/h, p = 0.550, respectively). Mean CPAP adherence at D8 was 4.7 ± 1.6 nights/wk and 1h00 ± 0h33 in the nonadherent children, vs. 6.9 ± 0.4 nights/wk and 7h16 ± 1h51 in the adherent group (p < 0.01). The mean number of nights per week at M1 was 6.4 ± 0.6 nights in nonadherent children (p = 0.086), and was equivalent to that in adherent children (6.8 ± 0.6 nights, p = 0.126). Mean adherence at M1 increased to 4h31 ± 1h12 in non-adherent children (p < 0.001), but was still lower when compared to that in adherent children (7h27 ± 2h00, p = 0.007)., Conclusion: The study findings imply that use of a simple table by a child appears to be effective in improving CPAP adherence at one month., (Copyright © 2018. Published by Elsevier B.V.)

Introduction: Mouthpiece ventilation represents a valuable treatment for patients needing daytime non-invasive ventilation. This modality is however underused, in part because of limitations in the available equipment., Objective: To develop a new flexible and moldable mouthpiece, aiming to address some of the issues of the currently available interfaces., Methods: We compared two commercially available and the newly developed mouthpieces in a bench test using four life-support home ventilators and three settings per ventilator., Results: The three interfaces showed marked differences in their resistive characteristics. In the volume-controlled setting (VC-CMV) with 500 mL tidal volume (V T ), the delivered V T , ranged between 459 ± 7 mL (-8%) and 501 ± 4 mL (+0.2%), according to the used ventilator. In the VC-CMV setting with V T 1000 mL, one of the ventilators did not assure the set V T with the new mouthpiece, because of the high-pressure limitation. In the pressure-controlled setting (PC-CMV at 20 cmH 2 O), the effective pressure differed between the tested interfaces according to their resistance, resulting in a decrease in the delivered V T ., Conclusions: They found measurable differences in the ventilation's performances comparing the interfaces for mouthpiece ventilation, which seem to have a minor clinical relevance in the most settings, but should be systematically checked. They validated in-vitro the newly developed mouthpiece with respect to the ventilation performances; a clinical study is needed to investigate the potential advantages we expect from the new mouthpiece., (© 2016 John Wiley & Sons Ltd.)

The aim of our study was to evaluate efficacy and reliability of currently available ventilators for mouthpiece ventilation (MPV). Five life-support home ventilators were assessed in a bench test using different settings simulating the specificities of MPV, such as intermittent circuit disconnection and presence of continuous leaks. The intermittent disconnection of the circuit caused relevant swings in the delivered tidal volume ( V T ), showing a V T overshoot during the disconnection periods and a V T decrease when the interface was reconnected to the test lung. The five ventilators showed substantial differences in the number of respiratory cycles necessary to reach a stable V T in the volume-controlled setting, ranging from 1.3 ± 0.6 to 7.3 ± 1.2 cycles. These differences were less accentuated in the volume-assisted setting (MPV-dedicated mode, when available). Our data show large differences in the capacity of the different ventilators to deal with the rapidly changing respiratory load features that characterize MPV, which can be further accentuated according to the used ventilator setting. The dedicated MPV modes allow improvement in the performance of ventilators only in some defined situations. This has practical consequences for the choice of the ventilator to be used for MPV in a specific patient.

Background and Aims: Even though numerous ventilators are licensed for a use in children, very few have been specifically developed for this age range. Therefore, home ventilators may not be able to adequately synchronize with the child's respiratory effort, and the inspiratory triggers (ITs) of assist modes are not always appropriate for children. The aim of the study was to test the improvement of the IT of a ventilator on a pediatric bench and in pediatric patients., Methods: A classical IT (ITc) and an improved IT [non-invasive ventilation (NIV) + IT] were tested on a bench with six pediatric profiles and in six young patients (mean age 14.1 ± 2.7 years old) requiring long-term NIV., Results: On the bench, trigger time delays (ΔT) and trigger pressures (ΔP) were reduced with the NIV + IT as compared with the ITc (ΔT: 0.481 ± 0.332 vs 0.079 ± 0.022 s for ITc and NIV + IT, respectively, P = 0.027; ΔP: -1.40 ± 0.70 vs -0.42 ± 0.28 cmH2 O for ITc and NIV + IT, respectively, P = 0.046). The clinical study confirmed the decrease in ΔT (0.267 ± 0.061 vs 0.178 ± 0.074 s for ITc and NIV + IT, respectively, P = 0.024) and ΔP (-0.68 ± 0.26 vs -0.39 ± 0.11 cmH2 O for ITc and NIV + IT, respectively, P = 0.030)., Conclusions: The sensitivity of the IT of a ventilator can be improved for pediatric use. The improvements observed on the bench study were confirmed in pediatric patients., (© 2014 John Wiley & Sons Ltd.)

Mouthpiece ventilation (MPV) allows patients with neuromuscular disease to receive daytime support from a portable ventilator, which they can disconnect at will, for example, for speaking, eating, swallowing, and coughing. However, MPV carries a risk of underventilation. Our purpose here was to evaluate the effectiveness of daytime MPV under real-life conditions. Eight wheelchair-bound patients who used MPV underwent daytime polygraphy at home with recordings of airflow, mouthpiece pressure, thoracic and abdominal movements, peripheral capillary oxygen saturation (SpO2), and transcutaneous partial pressure of carbon dioxide (PtcCO2). Times and durations of tasks and activities were recorded. The Apnea-Hypopnea Index (AHI) was computed. Patient-ventilator disconnections ≥3 minutes and episodes of hypoventilation defined as PtcCO2>45 mmHg were counted. Patient-ventilator asynchrony events were analyzed. The AHI was >5 hour(-1) in two patients. Another patient experienced unexplained 3% drops in arterial oxygen saturations at a frequency of 70 hour(-1). Patient-ventilator disconnections ≥3 minutes occurred in seven of eight patients and were consistently associated with decreases in SpO2 and ≥5-mmHg increases in PtcCO2; PtcCO2 rose above 45 mmHg in two patients during these disconnections. The most common type of patient-ventilator asynchrony was ineffective effort. This study confirms that MPV can be effective as long as the patient remains connected to the mouthpiece. However, transient arterial oxygen desaturation and hypercapnia due to disconnection from the ventilator may occur, without inducing unpleasant sensations in the patients. Therefore, an external warning system based on a minimal acceptable value of minute ventilation would probably be useful., (© The Author(s) 2015.)

Background: The battery life (BL) of portable home ventilator batteries is reported by manufacturers. The aim of this study was to evaluate the effects of ventilator mode, breathing frequency, PEEP, and leaks on the BL of 5 commercially available portable ventilators., Methods: The effects of the ventilator mode (volume controlled-continuous mandatory ventilation [VC-CMV] vs pressure support ventilation [PSV]), PEEP 5 cm H2O, breathing frequency (10, 15, and 20 breaths/min), and leaks during both volume-targeted ventilation and PSV on the BL of 5 ventilators (Elisée 150, Monnal T50, PB560, Vivo 50, and Trilogy 100) were evaluated. Each ventilator was ventilated with a test lung at a tidal volume of 700 ml and an inspiratory time of 1.2 s in the absence of leaks., Results: Switching from PSV to VC-CMV or the addition of PEEP did not significantly change ventilator BL. The increase in breathing frequency from 10 to 20 breaths/min decreased the BL by 18 ± 11% (P = .005). Leaks were associated with an increase in BL during the VC-CMV mode (18 ± 20%, P = .04) but a decrease in BL during the PSV mode (-13 ± 15%, P = .04)., Conclusions: The BL of home ventilators depends on the ventilator settings. BL is not affected by the ventilator mode (VC-CMV or PSV) or the addition of PEEP. BL decreases with an increase in breathing frequency and during leaks with a PSV mode, whereas leaks increase the duration of ventilator BL during VC-CMV., (Copyright © 2014 by Daedalus Enterprises.)