Optimizing Patient-Ventilator Synchrony During Invasive Ventilator Assist in Children and Infants Remains a Difficult Task*

Abstract

Asynchrony events are frequent during pressure support in children despite adjusting the cycling off criteria. Neurally adjusted ventilatory assist allowed for an almost ten-fold reduction in asynchrony events. Further studies should determine the clinical impact of these findings.

Neonatal and Adult ICU Ventilators to Provide Ventilation in Neonates, Infants, and Children: A Bench Model Study

“…In our pediatric ICU, 10% is the most frequently used ETS during invasive ventilation. 24 Interestingly, when a higher value of 25% (interquartile range of 21-29) was used during NIV, many premature cycling events were documented, suggesting that this threshold was too high even in the presence of leaks. As the Babylog VN500, a typical neonatal ventilator, has a non-modifiable ETS of only 15%, we decided to use this same value to test all ventilators to allow comparisons between the machines.…”

“…However, in our bench test, the trigger delays measured for the Servo-i were in line with the values reported in clinical settings. 8,9,24 Pressurization. In the pediatric literature, there are a striking lack of data on the possible clinical impact of pressurization capacities of mechanical ventilators.…”

“…The measured trigger delay in this scenario (in the presence of leaks and with the NIV algorithm activated) is similar to values reported previously in a clinical study performed in infants and children by our group. 24 Pressurization. For some adult ventilators, pressurization was impaired in the presence of leaks either with or without the NIV algorithm activated.…”

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

“…In the situation in which V O 2 is excessive in relation to oxygen delivery, the clinician should consider treating patient-ventilator dyssynchrony, titrating ventilator support to provide an appropriate patient work of breathing, and avoiding excessive patient agitation, shivering, and hyperthermia. 20,21 Patient-ventilator dyssynchrony [22][23][24] can lead to excessive V O 2 by the respiratory muscles. Dyssynchrony can be flow-related or trigger-related and occurs when spontaneous inspiratory effort is out of phase with the ventilatordelivered breaths.…”

“…Dyssynchrony can be flow-related or trigger-related and occurs when spontaneous inspiratory effort is out of phase with the ventilatordelivered breaths. [22][23][24] When dyssynchrony is present, primary hypoxemia due to ventilation/perfusion mismatching, mucous plugging, pneumothorax, and reactive airway disease must be eliminated as the etiology. When these causes are eliminated, altering the mode (ie, inspiratory flow pattern), improving the trigger sensitivity, or increasing the support provided by the ventilator may improve patientventilator synchrony.…”