"Evaluation of Different Inspiratory Efforts in a Pediatric Model of Healthy Lung and Pediatric Acute Respiratory Distress Syndrome During Optimized Pressure Support Ventilation and Proportional Assist Ventilation Plus (PAV+): A Bench Study.

Introduction: While proportional ventilator modes have gained popularity in adult patients' ventilatory management, Proportional Assist Ventilation (PAV+) use in pediatric patients with Pediatric Acute Respiratory Distress Syndrome (PARDS) remains unexplored. This study aims to evaluate the effects of optimized PSV and PAV+ on patient-ventilator interaction and respiratory pattern in two pediatric simulated lung models.

Methods: The study utilized an active lung simulator to replicate two pediatric lung models: one healthy and one with mild PARDS. Each model was ventilated using PAV+ and optimized PSV at four different levels, assessing simulated patient-ventilator interaction and mechanical response to increase inspiratory effort.

Results: In terms of simulated patient-ventilator interaction, in a healthy and mild PARDS lung model and all setting tested, the optimized PSV presented the better patient-ventilator interaction with the shortest values of Inspiratory trigger delay (Delay), Pressurization time (Time) and Expiratory trigger delay (Delay) and the highest values of Synchrony time (Time). Only in the lung model with PARDS, during high assistance levels and high Pmus, no significant differences were found in terms of patient ventilation interaction between the two modalities.

Conclusions: In a healthy lung model, optimized PSV allows optimal simulated patient-ventilator interaction and assistance levels compared to PAV+. On the contrary, in a simulated lung with mild PARDS, PAV+ appears as a valid alternative to PSV, especially under conditions of intense inspiratory effort and high assistance levels.