Because the child’s efforts are sometimes very slight, ventilators need to be sensitive enough to detect their inspiratory trigger.
- ResMed ventilators offer adjustable trigger sensitivities, allowing clinicians to choose a high or very high sensitivity to make triggering easier.
- ResMed ventilators allow oxygen to be connected directly to the ventilator, reducing the likelihood of triggering being compromised.
To achieve adequate minute ventilation, some clinicians advocate setting a fairly high backup rate.
- Astral™ ventilators offer a settable backup breath rate of up to 80 bpm, Stellar™ and the S9 VPAP™ ST-A up to 60 and 50 bpm.
- All ResMed ventilators indicated for pediatrics also offer the Pressure Assist Control (PAC) mode, allowing clinicians to set both a backup rate and a fixed inspiratory time.
Unintentional leaks are inevitable, especially for pediatric patients who may be moving about, or who don’t yet understand the need to keep the mask on.
- ResMed ventilators allow clinicians to set a “tight” Ti Max for pediatric patients to ensure that each breath terminates, even if there is large leak.
NIV can be used in acute respiratory failure.
- Astral ventilators are approved for pediatric patients (5 kg and above) in the hospital and the home. Stellar and S9 VPAP ST-A are indicated for patient weighing more than 15 kg or 30 lbs.
- Astral, Stellar and S9 VPAP ST-A all offer a comprehensive menu of alarm options, as well as integrated oximetry, making them ideal options for pediatric NIV use.
- In addition, Astral ventilators allow up to 40 L/min (Stellar offers 30 L/min) of oxygen to be connected directly to the device (as opposed to being “bled into” the circuit), and also offer an FiO2 monitoring option, suitable for hospital use.
For pediatric patients, it is important to ensure that the ventilator has appropriate alarms.
- All ResMed ventilation devices indicated for pediatrics include alarms such as power failure or device failure. Each device also offers settable alarm options such as non-vented mask, low SpO2, low minute ventilation, high leak and apnea alarm (Astral includes additional alarm capabilities like FiO2 when connected).
Skin irritation and facial flattening can occur from over-tightening the mask straps. To avoid this, some clinicians suggest offering all chronic pediatric patients at least two different styles of masks to vary the pressure points.
Mouthpiece ventilation can be tried in children at least 4 years old if they have good oro-motor control. Each patient must be evaluated to ensure appropriate alarms are used in case of circuit disconnection or loss of mouthpiece from the lips.
Heated humidification often helps patients be more comfortable and avoid increasing airway resistance.
- Compatible with the Stellar series of ventilators, the H4i™ is a simple-to-use, integrated heated humidifier.
- ResMed’s S9 VPAP ST-A device includes advanced humidification technology: Climate Control with the H5i™ heated humidifier.
- ResMed ventilators are compatible with external humidifiers, including the Astral life support ventilator. Please review the device clinical guide for details.
Many children on NIV also require nebulizer therapy. Because breathing for these children is typically very shallow, it is helpful for them to take their nebulizer treatment while on NIV to ensure deeper inhalation and better medication deposition.
- ResMed ventilation devices allow clinicians to use the PAC mode, which ensures a specified breath rate and inspiratory time.
- Alternatively, Astral, Stellar and VPAP devices (on the S9 platform) allow clinicians to set the Ti Min, which will ensure a minimum inspiratory time in S and ST modes.
Pediatric patients are often prescribed an oximeter.
- Astral’s oximetry alarms are available when the pulse oximeter is connected to the device. The alarms are enabled even when the ventilator is in standby. Oxygen saturation and pulse rate alarms activate when the monitored SpO2 parameter exceeds the corresponding alarm setting (with no delay).
- Stellar ventilators and the S9 VPAP ST-A offer an integrated oximeter with alarms. The integrated oximeter simplifies the caregiver’s routine because there are fewer devices to carry around and learn how to operate.
It is important for children on NIV and their families to participate in normal activities and excursions that promote bonding and quality of life.
- Astral is equipped with an 8-hour internal battery (Stellar offers a 4-hour internal battery), for extra mobility. Astral also offers the capability of pairing up to two additional external batteries, for a total of 24 hours* of battery support.
- Additionally, many ResMed ventilators can accommodate the ResMed Power Station II (RPS II), which can provide 8 to 16 hours* of battery duration (depending on how many batteries are used).
- The batteries allow greater freedom and mobility for pediatric patients dependent on their ventilator, facilitating the continuity of therapy while still allowing a greater level of participation in day-to-day activities.
* 8 hours per battery in PAC mode at EPAP 5 cm H2O, IPAP 15 cm H2O and 20 bpm (two batteries can be connected simultaneously)