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100 ms matter: Impact of back-up Ti on triggered breaths in pediatric NIV

Sonia Khirani1, Lucie Griffon2, Marine Dosso3

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

Sleep Medicine
|August 10, 2025
PubMed

Insights

Adjusting ventilator inspiratory time (Ti) in pediatric noninvasive ventilation (NIV) can optimize breath delivery for children with neuromuscular disorders (NMD). This adaptation impacts the balance between triggered and controlled breaths, improving respiratory support.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Mechanics
  • Mechanical Ventilation

Background:

  • Noninvasive ventilation (NIV) is crucial for managing pediatric respiratory insufficiency, particularly in neuromuscular disorders (NMD).
  • Pressure support ventilation (PSV) is common for home NIV, utilizing inspiratory trigger (TgI) and expiratory trigger (TgE) sensitivities.
  • Current guidelines lack specific parameters for adjusting TgI based on patient age or disease, leading to varied clinical practices.

Purpose of the Study:

  • To investigate the impact of adjusting the back-up inspiratory time (Ti) on the triggered/controlled breath ratio in pediatric patients undergoing NIV.
  • To explore an alternative approach to managing ventilator settings in children with NMD, focusing on optimizing respiratory muscle rest.

Main Methods:

  • Case series of 4 children, including two with NMD or suspected NMD, receiving home NIV.
  • Analysis of ventilator settings, specifically focusing on the adaptation of the back-up inspiratory time (Ti).
  • Evaluation of the triggered/controlled breath ratio in response to adjusted Ti settings.

Main Results:

  • Adaptation of the back-up inspiratory time (Ti) directly influenced the ratio of triggered to controlled breaths.
  • In patients with NMD, high TgI sensitivity did not necessarily lead to excessive patient triggering when ventilation was efficient.
  • The study suggests that optimizing Ti can be a key factor in managing NIV in this population.

Conclusions:

  • Adjusting the back-up inspiratory time (Ti) is a viable strategy to modulate breath delivery in pediatric NIV.
  • This approach may enhance ventilator synchrony and optimize respiratory muscle rest in children with NMD.
  • Further research is warranted to establish evidence-based guidelines for NIV parameter adjustment in pediatric NMD.

Keywords:
Back-up inspiratory timeInspiratory triggerNeuromuscular disordersNoninvasive ventilationPediatrics

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