Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

Estay, Alberto; Claure, Nelson; D'Ugard, Carmen; Organero, R; Bancalari, Eduardo

doi:10.1038/jp.2009.187

Cited by 21 publications

(9 citation statements)

References 14 publications

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“…7 The benefits of reducing instrumental dead space or mitigating its effects are well-recognized and discussed in the literature. 8,9 Multiple approaches to reduce instrumental dead space and/or its effects on patients have been proposed; 3,[8][9][10][11][12][13][14][15] these suggestions even include using lung assist with extracorporeal CO 2 removal. 16 However, trimming the endotracheal tube (ETT) seems to be the only widely accepted method.…”

Section: Introductionmentioning

confidence: 99%

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Ivanov

2015

Respir Care

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BACKGROUND: The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO 2 elimination in a model of the premature neonate lung. METHODS: The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO 2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. RESULTS: The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (V T ) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO 2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO 2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and 2.5% (not significant); the insert-equipped standard connector increased it by 0.8% (not significant), 2.5% (P < .01), and 2.8% (P < . IntroductionVentilator-induced lung injury is considered an important causative factor in the pathophysiology of bronchopulmonary dysplasia (BPD) in premature infants. 1 Limiting ventilator-associated lung overdistention/damage is a well-recognized approach for the prevention of BPD, but Dr Ivanov is affiliated with the Section

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Section: Introductionmentioning

confidence: 99%

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Ivanov

2015

Respir Care

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“…This was clearly shown by an increased diaphragmatic activity as well as significant changes in neural breathing variability during the trial. Although, it is well known that the presence of an ETT and ventilator apparatus increase dead space and respiratory resistance, 38 , 39 the response of extremely preterm infants to this challenge has not been well outlined. It was also interesting to note that the ability to mount such respiratory effort occurred in response to a quite short trial.…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants

et al. 2020

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Background Extremely preterm infants are often exposed to endotracheal tube continuous positive airway pressure (ETT-CPAP) trials to assess extubation readiness. The effects of ETT-CPAP trial on their diaphragmatic activity (Edi) and breathing variability is unknown. Methods Prospective observational study enrolling infants with birth weight ≤1250 g undergoing their first extubation attempt. Diaphragmatic activity, expressed as the absolute minimum (Edi min) and maximum values (Edi max), area under the Edi signal, and breath-by-breath analyses for breath areas, amplitudes, widths, and neural inspiratory and expiratory times, were analyzed during mechanical ventilation (MV) and ETT-CPAP. Neural breathing variability of each of these parameters was also calculated and compared between MV and ETT-CPAP. Results Thirteen infants with median (interquartile range) birth weight of 800 g [610–920] and gestational age of 25.4 weeks [24.4–26.3] were included. Diaphragmatic activity significantly increased during ETT-CPAP when compared to MV:Edi max (44.2 vs. 38.1 μV), breath area (449 vs. 312 μV·s), and amplitude (10.12 vs. 7.46 μV). Neural breathing variability during ETT-CPAP was characterized by increased variability for amplitude and area under the breath, and decreased for breath time and width. Conclusions A 5-min ETT-CPAP in extremely preterm infants undergoing extubation imposed significant respiratory load with changes in respiratory variability. Impact ETT-CPAP trials are often used to assess extubation readiness in extremely preterm infants, but its effects upon their respiratory system are not well known. Diaphragmatic activity analysis demonstrated that these infants are able to mount an important response to a short trial. A 5-min trial imposed a significant respiratory load evidenced by increased diaphragmatic activity and changes in breathing variability. Differences in breathing variability were observed between successful and failed extubations, which should be explored further in extubation readiness investigations. This type of trial cannot be recommended for preterm infants in clinical practice until clear standards and accuracy are established.

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“…The authors demonstrated when the dead space in ETT connectors was decreased artificial lung ventilation improved, even though a slight increase in airway resistance and work of breathing occurred (6). Authors commented on this conflicting finding as the increase in resistance and work of breathing may affect patients especially during weaning as the importance of reduction in the instrumental dead space during weaning was previously emphasized (9).…”

Section: Discussionmentioning

confidence: 99%

Effects of a closed system suction connector on airwayresistance in ventilated neonates

Ünal¹,

Ergenekon²,

Kazancı³

et al. 2017

Turk J Med Sci

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Background/aim: Increased airway resistance reduces the effectiveness of ventilation treatment. Endotracheal tubes (ETTs) and connectors contribute to resistance. However, the effect of a closed system suction (CSS) connector is not well known. We compared the in vivo resistance occurring with a CSS connector with that of the standard connector. Materials and methods: This prospective study was conducted at Gazi University Hospital's neonatal intensive care unit. Intubated neonates were studied for two cycles; each cycle contained two periods of ETT + connector pairs (15 min/period) as follows: cycle 1 [A: long ETT + standard connector; B: long ETT + CSS connector] and cycle 2 [C: shortened ETT + standard connector; D: shortened ETT + CSS connector]. Resistance of 40 breaths/period was averaged for each case, and the means were analyzed by Wilcoxon test for pairwise comparisons between standard and CSS connectors. As each case provided two cycle data, 16 cycle data were compared. Results:The CSS connector increased resistance by 13.8% (range: 3.0%-22.1%) compared to the standard connector; P < 0.001. The resistance increase was similar between long [17.3% (range: 3.0%-17.7%)] and shortened ETTs [15.3% (range: 5.0%-29.6%)]; P = 0.834. Conclusion:CSS connectors were found to increase airway resistance in ventilated neonates. The contribution of CSS should be considered during ventilation, particularly in the presence of difficulty in providing sufficient tidal volume.

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Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

Cited by 21 publications

References 14 publications

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants

Effects of a closed system suction connector on airwayresistance in ventilated neonates

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