In infants with fluctuations in Spo(2), automated Fio(2) adjustment improved maintenance of the intended Spo(2) range led to reduced time with high Spo(2) and more-frequent episodes with Spo(2) between 80% and 86%.

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Nasal ventilation is increasingly used to reduce invasive ventilation in preterm infants. The effects of nasal ventilation and the advantages of synchronized nasal ventilation have not been fully evaluated. The objective was to compare the short-term effects of nasal intermittent mandatory ventilation (NIMV) and synchronized NIMV (S-NIMV) with nasal continuous positive airway pressure (NCPAP) on ventilation, gas exchange, and infant-ventilator interaction. Sixteen clinically stable preterm infants requiring NCPAP (GA, 27.6 Ϯ 2.3 wk; birthweight (BW), 993 Ϯ 248 g; and age, 15 Ϯ 14 d) were exposed to NCPAP, NIMV at 20/min, NIMV at 40/min, S-NIMV at 20/min, and S-NIMV at 40/min for 1 h each (Infant-Star ventilator), in random order. Tidal volume, minute ventilation, and gas exchange did not differ significantly between NCPAP, NIMV, and S-NIMV. Inspiratory effort decreased during S-NIMV compared with NCPAP and NIMV, whereas inspiratory effort during NIMV did not differ from NCPAP. Active expiratory effort and expiratory duration increased during NIMV. Chest wall distortion, apnea and hypoxemia spells, abdominal girth, and comfort did not differ. In conclusion, there were no short-term benefits on ventilation and gas exchange of nasal ventilation compared with NCPAP in clinically stable preterm infants. However, synchronized nasal ventilation reduced breathing effort and resulted in better infant-ventilator interaction than nonsynchronized nasal ventilation. (Pediatr Res 69: 84-89, 2011) D espite advances in neonatal respiratory care, bronchopulmonary dysplasia remains a frequent complication in preterm infants, and invasive mechanical ventilation is a major risk factor (1,2). This led to the use of noninvasive respiratory support to reduce complications associated with invasive mechanical ventilation in preterm infants. Nasal continuous positive airway pressure (NCPAP) is the most common form of noninvasive respiratory support used in these infants. However, studies have shown important failure rates of NCPAP in preventing invasive ventilation or after extubation in the smaller infants (3-5). Efforts to reduce failure prompted the use of nasal ventilation that has been found to be more effective than NCPAP in preventing extubation failure (6 -9) and as a primary mode of support in respiratory distress syndrome (RDS) (10 -12).The most commonly reported modes of nasal ventilation are nasal intermittent mandatory ventilation (NIMV) and synchronized NIMV (S-NIMV). However, the effects of nasal ventilation on respiratory function and the possible advantages of synchronization during nasal ventilation have not been fully evaluated.The objective of this study was to evaluate the physiologic effects of synchronization during nasal ventilation in stable preterm infants. It was hypothesized that S-NIMV will improve tidal volume (V T ) and minute ventilation (V E ) when compared with NCPAP and nonsynchronized NIMV. Second, it will improve gas exchange, reduce patient effort and chest wall distortion, and decrease ...

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