title: Improvement of the trigger of a ventilator for non-invasive ventilation in children: bench and clinical study.
abstract: OBJECTIVE
  Even though numerous ventilators are licensed for a use in children, very few have been specifically developed for this age range. Therefore, home ventilators may not be able to adequately synchronize with the child's respiratory effort, and the inspiratory triggers (ITs) of assist modes are not always appropriate for children. The aim of the study was to test the improvement of the IT of a ventilator on a pediatric bench and in pediatric patients.
  
  
  METHODS
  A classical IT (ITc) and an improved IT [non-invasive ventilation (NIV) + IT] were tested on a bench with six pediatric profiles and in six young patients (mean age 14.1 ± 2.7 years old) requiring long-term NIV.
  
  
  RESULTS
  On the bench, trigger time delays (ΔT) and trigger pressures (ΔP) were reduced with the NIV + IT as compared with the ITc (ΔT: 0.481 ± 0.332 vs 0.079 ± 0.022 s for ITc and NIV + IT, respectively, P = 0.027; ΔP: -1.40 ± 0.70 vs -0.42 ± 0.28 cmH2 O for ITc and NIV + IT, respectively, P = 0.046). The clinical study confirmed the decrease in ΔT (0.267 ± 0.061 vs 0.178 ± 0.074 s for ITc and NIV + IT, respectively, P = 0.024) and ΔP (-0.68 ± 0.26 vs -0.39 ± 0.11 cmH2 O for ITc and NIV + IT, respectively, P = 0.030).
  
  
  CONCLUSIONS
  The sensitivity of the IT of a ventilator can be improved for pediatric use. The improvements observed on the bench study were confirmed in pediatric patients.
authors.affiliation: S2A Santé, Ivry-sur-Seine, France.|AP-HP, Pediatric Pulmonary Department, Hôpital Armand Trousseau, Paris, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Khirani
authors.affiliation: INSERM U955, Equipe 13, Université Paris Est, Créteil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Louis
authors.affiliation: ADEP ASSISTANCE, Suresnes, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Leroux
authors.affiliation: AP-HP, Pediatric Pulmonary Department, Hôpital Armand Trousseau, Paris, France.|ADEP ASSISTANCE, Suresnes, France.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ramirez
authors.affiliation: INSERM U955, Equipe 13, Université Paris Est, Créteil, France.|AP-HP, Physiology Department, Hôpital Raymond Poincaré, Garches, France.|EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
authors.affiliation: AP-HP, Pediatric Pulmonary Department, Hôpital Armand Trousseau, Paris, France. brigitte.fauroux@nck.aphp.fr.|INSERM U955, Equipe 13, Université Paris Est, Créteil, France. brigitte.fauroux@nck.aphp.fr.|Université Pierre et Marie Curie-Paris 6, Paris, France. brigitte.fauroux@nck.aphp.fr.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007223:Infant; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D012131:Respiratory Insufficiency / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: bench study; child; inspiratory trigger; non-invasive ventilation; time delay