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The conventional pneumatic triggering used in PAV+ ventilation appears as an important limitation especially when compared to the other proportional mode of ventilation (neurally adjusted ventilatory assist), in which the triggering by the electrical activity of the diaphragm (Eadi) is not affected by PEEPi [14, 15].
Comfort of breathing was also lower during pneumatic triggering compared to neural triggering.
PSV, the most commonly used ventilatory support during NIV, is regulated by pneumatic triggering based on flow criteria.
Autotriggered breaths in NAVA may be explained by the pneumatic triggering, which can be activated, besides neural triggering, on a first-come, first-served principle.
In contrast, pneumatic triggering is more complex and considerably affected by leakage, which can only be partly compensated for by dedicated NIV algorithms [ 7].
The pneumatic trigger was delayed compared to the neural trigger and directly increased with the level of PSV; during pneumatic triggering the number of wasted efforts increased with high PSV, while wasted inspiratory efforts did not occur during neural triggering.
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This trigger is a pneumatic trigger or a trigger based on the EAdi signal.
Pneumatic trigger set to pressure instead of flow might limit the rebound in inspiratory flow.
Therefore, a pneumatic trigger was rewarded before onset of the diaphragmatic signal.
We could analyze some cycles triggered by a pneumatic trigger as asynchronous cycles (auto-triggering followed by ineffective efforts).
Similarly, Breatnach and colleagues compared NAVA (with a neural trigger) and PSV (with a pneumatic trigger) in 16 ventilated infants [ 31].
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