Asynchrony During Pediatric Noninvasive Ventilation With a Nasal Cannula Interface: A Lung Model Study

Pediatric noninvasive ventilation (NIV) is used commonly in the acute care setting and is associated with high incidence of patient ventilator asynchrony. An ASL 5000 breathing simulator was used to model pediatric patients with varying patient efforts and lung conditions. For delivery of NIV, a commonly used acute care ventilator was used by connecting a nasal cannula interface to model nares produced with a 3-dimensional printer. The modes of ventilation were NIV pressure control continuous mandatory ventilation and NIV pressure control continuous spontaneous ventilation. Patient and ventilator waveforms were analyzed using the ASL 5000 software to assess for asynchrony events and determine the asynchrony index (AI). Significant asynchrony (AI > 0.1) existed in the majority of scenarios for both pressure control continuous mandatory ventilation and pressure control continuous spontaneous ventilation (79% and 93%, respectively). The most common asynchrony event was ineffective trigger, accounting for 81.9% of events in pressure control continuous mandatory ventilation and 79.3% in pressure control continuous spontaneous ventilation. There were no statistically significant differences in the AI when comparing simulated patient effort or lung condition. Significant asynchrony exists during NIV with a commonly used acute care ventilator and nasal cannula interface, which raises questions regarding its utility in clinical practice in the pediatric population.