Why breath-by-breath tidal volume is useful for HMV monitoring?

Home mechanical ventilation (HMV), including noninvasive ventilation (NIV) and invasive mechanical ventilation, is increasingly used in pediatrics. Monitoring HMV is essential to guarantee an effective ventilation, but also to adjust the settings, when necessary. Monitoring HMV using breath-by-breath tracings, such as pressure, airflow and leaks, allows the detection of respiratory events and patient-ventilator asynchrony (PVA), when polysomnography/polygraphy is not available or feasible. Most built-in software provide the breath-by-breath tracing of tidal volume (VT), which appears to be helpful to characterize some PVA, and is of particular interest to identify patient-ventilator uncoupling, according to our clinical experience. We present a few cases illustrating the beneficial adjunct of breath-by-breath VT for PVA detection and characterization. We believe healthcare professionals should display and use breath-by-breath VT, when available on the built-in software, to ease HMV monitoring, especially in absence of other measurements of patient's effort, such as thoraco-abdominal belts.