Pressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation: A pilot crossover trial in premature infants in their weaning phase

Abstract

The potentials of PSV-VG to improve infant-ventilator synchrony and to decrease pressure needed to ventilate premature lungs are promising, even though the changes were small. However, its benefits during acute illness and on the final outcome remain to be proven.

The effect of two levels of pressure support ventilation on tidal volume delivery and minute ventilation in preterm infants

“…This has not been reported before in newborns but mirrors the observations made in paediatric and adult patients 11. There are limited data comparing various levels of PSV,12 – 14 but these studies suggest that the addition of PSV during weaning augments spontaneous breathing with better thoraco-abdominal synchrony, increase in minute ventilation, and reduction in the total respiratory rate compared with SIMV alone 15…”

Methods and evidence on volume-targeted ventilation in preterm infants

“…This would, in addition to volume targeting, provide synchrony at the onset and end of spontaneous inspiration. PSV plus volume-guarantee in the early or weaning phases of RDS and following surfactant administration achieved only slight weaning of PIP in comparison to pressure-limited SIMV [7,[9][10][11].…”

Randomised weaning trial comparing assist control to pressure support ventilation

“…With some ventilator types, the ‘level’ can be set by the clinician and is sometimes called termination sensitivity, while with other ventilators the ‘level’ is fixed. PSV compared with SIMV has been associated with superior breathing rhythmicity 2. In another study,3 as the level of termination sensitivity was increased, the occurrence of asynchrony was decreased, but that was at the expense of shortened inflation times.…”

“…In another study,3 as the level of termination sensitivity was increased, the occurrence of asynchrony was decreased, but that was at the expense of shortened inflation times. Despite the lower level of peak inflating pressure provided by the ventilator during PSV compared with ACV/SIMV blood gases, at least in short-term studies, were maintained 2 4. The reduced level of ventilator support, however, could lead to an increase in the work of breathing and muscle fatigue, adversely affecting respiratory muscle strength.…”