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Why NIV setting definitions may be tricky: Trigger sensitivity.

Sonia Khirani1, Lucie Griffon2, Anais Le3

  • 1ASV Santé, Gennevilliers, France; Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP Necker Hospital, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, Paris, France.

Sleep Medicine
|November 18, 2024
PubMed
Summary
This summary is machine-generated.

Incorrect settings on home noninvasive ventilation (NIV) devices can cause patient-ventilator asynchrony (PVA). Harmonizing trigger sensitivity definitions is crucial for safe and effective pediatric NIV therapy.

Keywords:
Noninvasive ventilationPatient-ventilator asynchronyPediatricsSetting definitionsTrigger sensitivity

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Area of Science:

  • Pediatric Pulmonology
  • Biomedical Engineering
  • Respiratory Care

Background:

  • Noninvasive ventilation (NIV) is a common respiratory support for children.
  • The spontaneous/timed (S/T) mode is frequently used for home NIV.
  • Device settings, particularly trigger sensitivities, lack standardization across manufacturers.

Purpose of the Study:

  • To highlight the challenges and consequences of non-standardized trigger sensitivity settings in pediatric home NIV.
  • To advocate for harmonization of NIV device settings to prevent patient-ventilator asynchrony (PVA).

Main Methods:

  • Case series reporting on four children and adolescents experiencing PVA.
  • Analysis of incorrect inspiratory trigger (TgI) and/or expiratory trigger (TgE) sensitivity settings.
  • Review of differing manufacturer definitions for trigger sensitivity adjustments.

Main Results:

  • Incorrect settings of TgI and/or TgE were identified as the cause of PVA in the reported cases.
  • Variability in setting scales (numerical, word-rating, percentage of peak inspiratory flow) contributes to confusion.
  • Confusing definitions for expiratory trigger sensitivity (TgE) further complicate proper device configuration.

Conclusions:

  • Patient-ventilator asynchrony (PVA) in pediatric home NIV can result from user misinterpretation of varied device settings.
  • Harmonization of trigger sensitivity definitions is urgently needed to improve NIV safety and efficacy.
  • Healthcare professionals must be aware of current setting discrepancies to mitigate risks of PVA.