The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

THE USE OF VARIABLE TRIGGER SENSITIVITY ON A NON-INVASIVE VENTILATED PEDIATRIC PATIENT: A CASE REPORT.

Mike Robertson; Respiratory Care, Nationwide Childrens Hospital, Columbus, OH

Introduction The use of non-invasive ventilation (NIV) to treat acute respiratory failure has increased dramatically in recent years has been successful in the pediatric population. However, with many pediatric patients, the inability to trigger the device can lead to; ineffective triggering, auto triggering, increased work of breathing, longer duration on the device, and potential invasive ventilation. The Philips Respironics V60 is equipped with Auto-Trak + software which allow clinicians to assist pediatric patients with their trigger and cycling needs. The application of Auto-Trak + in an acute respiratory failure pediatric patient is reported. Case Summary An 8 month, 5.2 kg patient was receiving mechanical ventilation for respiratory failure secondary to a large patent ductus arteriosus. The patient had previously failed multiple extubation attempts due to inability to appropriately trigger a non-invasive support device resulting in re-intubation. The last time the patient was extubated he was placed on a Respironics V60 with settings: IPAP 14, EPAP 8, I-Time 0.5 sec, rate 35 and monitored for effectiveness. The Auto-Trak+ trigger sensitivity was initiated and titrated until asynchrony index was < 10%. Asynchrony was detected by visual inspection and the asynchrony index (AI) was calculated. Ineffective triggering was defined as an airway pressure drop (= 0.5 cmH2O) simultaneous to a flow decrease and not followed by an assisted breath. Prior to auto-trak + initiation, the patient’s AI was 17%, RR 80, HR 161, Sp02 80% with noticeable work of breathing. Figure one clearly shows the patient’s inability to appropriately trigger the machine. After the increase in trigger sensitivity, the patient’s AI reduced to 1%, RR 44, HR 120, Sp02 98% and a decrease in work of breathing. With the help of variable trigger sensitivity, the patient was able to avoid re-intubation and transitioned off of non-invasive ventilation. Discussion The ability to accurately control trigger sensitivity can assist selected pediatric patients with their trigger and cycling needs while auto-adjusting during changing leaks. AutoTrak+ may help in making noninvasive therapy more comfortable for the patient and more versatile for the clinician. Whether adjustable trigger sensitivity allows the V60 to reduce asynchrony on all pediatric patients cannot be determined from this single case study and should be the subject of future investigations. Sponsored Research - None Figure 1