The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

TRIGGER SENSITIVITY OF NON-INVASIVE VENTILATORS IN A PEDIATRIC LUNG MODEL

Craig D. Smallwood, Brian K. Walsh; Respiratory Care, Children’s Hospital Boston, Boston, MA

Background: Non-invasive ventilation (NIV) has been used with increasing success in children and adults with moderate acute or chronic respiratory insufficiency. However, in the smaller pediatric patients (<20kg) many cannot trigger the ventilator and require mandatory rates which may elicit discomfort. The trigger sensitivity of current NIV devices may not be responsive enough to meet the requirements of these smaller patients requiring increase sedation and potentially invasive ventilation. In addition some ventilators have sufficient trigger sensitivity in a sealed system, but when a leak is present may auto-trigger and hyperventilate the patient. These concerns lead us to bench test several NIV and ICU ventilators to help determine which device may provide the best coordination of effort and support in our patient population. Methods: Six ventilators were tested: Respironcs Vision and V60, Draeger Carina, Viasys Avea and Vela, Maquet Servoi, and Pulmonetics LTV 1200. Following manufacture pre-use set-up, each ventilator was tested with an adult circuit duel limb (ICU ventilators) or single limb (NIV ventilators) circuit connected without a humidifier. An active servo lung (ASL 5000) was used to assess triggering of the previously listed ventilators. The lung model was set to attempt 15 bpm of ramping flow effort from 1 to 10 L/min. The flow at which the ventilator triggered 80% or more of the test breaths was deemed successful. This test was performed both with and without an external circuit leak. The number of breaths that triggered the ventilator was recorded. Asynchrony was observed and recorded and the asynchrony index (AI) was calculated for each ventilator. Results: Please see graph Conclusion: Presently, critical care ventilators are the most sensitive. However, in the setting of a moderate leak auto-triggering may outweigh the potential benefits of a more sensitive trigger. Further development of non-invasive ventilators is needed to meet the specific triggering requirements of pediatric patients in the presence of a leak. Sponsored Research - None

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