A New Tool to Assess Patient-Ventilator Synchrony in Preterm Infants Receiving Non-Invasive Ventilation: A Randomized Crossover Pilot Study.

Summary

The SyncNIV automated algorithm quantified patient-ventilator synchrony in preterm infants and showed significantly higher i-SI during nSIPPV versus nIPPV in a randomized crossover pilot (n=14). The tool processed over 90,000 combined breaths/inflations, supporting its feasibility for real-time monitoring and parameter optimization.

Key Findings

• SyncNIV analyzed 43,304 ventilator inflations and 50,221 patient breaths in 14 preterm infants.
• Instant Synchrony Index was significantly higher with nSIPPV (median ~55%) versus nIPPV (median ~40%) (p<0.05).
• Demonstrated feasibility of automated, breath-by-breath synchrony monitoring using a custom signal-analysis algorithm.

Clinical Implications

Bedside synchrony monitoring may help select nSIPPV over nIPPV when appropriate and fine-tune parameters to reduce work of breathing and NIV failure risk.

Limitations

• Small single-center pilot (n=14) limits generalizability
• Physiological endpoints without assessment of clinical outcomes (e.g., NIV failure, BPD)

Future Directions

Prospective multicenter validation with clinical endpoints; integration into ventilator software for real-time feedback and closed-loop triggering; assessment of impact on NIV failure and long-term outcomes.