Trigger performance of five pediatric home ventilators and one ICU ventilator depending on circuit type and system leak in a physical model of the lung

Abstract

Background: The population of children with chronic respiratory failure requiring long-term mechanical ventilation in the home has grown worldwide. The optimal choice from an increasing number of home ventilators commercialized for children is often challenging for the attending physicians. The aim of the present study was to compare the trigger performance of five pediatric bilevel home ventilators and one intensive care unit ventilator depending on circuit type and system leak. Methods:The trigger performances of the ventilators were compared in combination with all compatible circuits using a physical model of the lung with increasing system leak. The flow generator simulated the patient's breathing effort with flow rates of 2.7-6.4 L/min at a frequency of 30 breaths/min. All ventilators were set to deliver 16 cmH 2 O inspiratory pressure support and 4 cmH 2 O positive endexpiratory pressure.

Mask interfaces and devices for home noninvasive ventilation in children

“…12,47 Therefore, the choice of the device will be based on its capacity to detect the patient's inspiratory flows, 39 and particularly for "weak" patients such as infants or young children with neuromuscular diseases. 9,47,48 Indeed, patient-ventilator asynchrony, such as trigger and cycling asynchronies, or ineffective efforts, can result either because of inappropriate settings or major leaks, but also in case of an inadequate device. 14,49,50 The clinical consequences of patient-ventilator asynchrony may concern sleep disruption, comfort, NIV efficiency, and nocturnal gas exchange, but require further investigation.…”

“…Contrarily to CPAP, all BPAP devices commercially available are not suitable to safely deliver BPAP in children with spontaneous respiratory effort. Indeed, the device needs to be sensitive enough to detect the patient's effort to either initiate a positive pressure breath (trigger) or terminate the breath (cycle) 12,47 . Therefore, the choice of the device will be based on its capacity to detect the patient's inspiratory flows, 39 and particularly for “weak” patients such as infants or young children with neuromuscular diseases 9,47,48 .…”

“…Indeed, the device needs to be sensitive enough to detect the patient's effort to either initiate a positive pressure breath (trigger) or terminate the breath (cycle) 12,47 . Therefore, the choice of the device will be based on its capacity to detect the patient's inspiratory flows, 39 and particularly for “weak” patients such as infants or young children with neuromuscular diseases 9,47,48 . Indeed, patient‐ventilator asynchrony, such as trigger and cycling asynchronies, or ineffective efforts, can result either because of inappropriate settings or major leaks, but also in case of an inadequate device 14,49,50 .…”