Randomized controlled trial of volume-targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy

Mrozek, Jeanne D.; Bendel-Stenzel, Ellen; Meyers, Pat A.; Bing, Dennis R.; Connett, John E.; Mammel, Mark C.

doi:10.1002/(sici)1099-0496(200001)29:1<11::aid-ppul3>3.0.co;2-5

Cited by 46 publications

(18 citation statements)

References 30 publications

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“…[13][14][15][16] There have also been several small short-term clinical trials of PC-SIMV versus PC-IMV or PC-CMV versus PC-IMV. [13][14][15][16][17][18][19][20] Overall, in neonates, PC-CMV has shown less V T variability, shorter weaning time, lower WOB, and better blood gas values and vital signs than PC-SIMV, and lower WOB and shorter duration of weaning than PC-IMV. 15 A recent Cochrane meta-analysis 21 evaluated 14 RCTs and compared differences in outcomes with patient-triggered ventilation versus non-patient-triggered ventilation (eg, PC-IMV).…”

Section: Continuous Mandatory Ventilation and Synchronized Intermittementioning

confidence: 90%

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Mechanical Ventilation of the Premature Neonate

Brown

DiBlasi

2011

Respir Care

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Section: Continuous Mandatory Ventilation and Synchronized Intermittementioning

confidence: 90%

“…7,[17][18][19][20][21][22] It may, however, be more important to choose the correct ventilation strategy, once the ventilation mode is chosen. There is evidence that optimization of the lung volume is key to lung protection, regardless of what ventilation mode is used.…”

Section: Lung-protective Strategiesmentioning

confidence: 99%

Mechanical Ventilation of the Premature Neonate

Brown

DiBlasi

2011

Respir Care

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“…The mean difference between settings of 30 min À1 and 50 min À1 was 6 min À1 (99% confidence interval [3][4][5][6][7][8][9]. No statistically significant differences were observed in delivered PIP or changes in TcCO 2 , FiO 2 , SpO 2 , HR or BP.…”

Section: Resultsmentioning

confidence: 86%

“…Synchronized intermittent mandatory ventilation provides a fixed number of triggered inflations per minute. AC has been associated with reduced patient effort 4,5 and reduced variability of tidal volume, 6 particularly when combined with volume guarantee (VG). 4,7 In AC mode, the ventilator rate varies with the breathing pattern of the infant.…”

Section: Introductionmentioning

confidence: 99%

Lower back-up rates improve ventilator triggering during assist-control ventilation: a randomized crossover trial

et al. 2011

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Objective: The objective of this study is to compare the effects of back-up ventilation rates (BURs) on triggered inflations and patient cardiorespiratory stability during assist-control/volume guarantee ventilation (AC/VG).Study Design: This study is a randomized crossover trial conducted in a neonatal unit in an Australian tertiary NICU. In all, 26 stable preterm infants on AC/VG ventilation were studied at BUR settings of 30, 40 and 50 min À1 . Inflation rate, triggering and cardiorespiratory measures of patient stability were compared during 20 min epochs with 10 min washout periods.Result: The 26 infants studied were median (inter-quartile range) gestational age 27 (26, 30) weeks, birth weight 0.84 (0.75, 1.14) kg and FiO 2 0.24 (0.21, 0.31) and age 6 (4, 19) days. At BURs of 30, 40 and 50, the proportions of inflations, which were triggered, were mean (s.d.) 85% (11), 75% (19) and 61% (25); P<0.01 for all comparisons. Total delivered inflation rates were 56 (8), 58 (9) and 62 (8) min À1 , respectively. Cardiorespiratory parameters did not vary between the settings.Conclusion: Using a lower BUR allows greater triggering of ventilator inflations. Cardiorespiratory parameters including CO 2 levels were stable at all rates.

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“…Short-term clinical trials have demonstrated smaller and less variable V T , less tachypnea, more rapid weaning from mechanical ventilation and smaller fluctuations in blood pressure with AC, when compared to SIMV. [13][14][15][16] There are important physiological considerations suggesting that SIMV may not provide optimal support in very premature infants. However, many clinicians still prefer SIMV, especially for weaning from mechanical ventilation.…”

Section: Choice Of Synchronized Modesmentioning

confidence: 99%

State of the art in conventional mechanical ventilation

Keszler

2009

J Perinatol

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Despite a shift to noninvasive respiratory support, mechanical ventilation remains an essential tool in the care of critically ill neonates. The availability of a variety of technologically advanced devices with a host of available modes and confusing terminology presents a daunting challenge to the practicing neonatologist. Many of the available modes have not been adequately evaluated in newborn infants and there is paucity of information on the relative merits of those modes that have been studied. This review examines the special challenges of ventilating the extremely low birth weight infants that now constitute an increasing proportion of ventilated infants, attempts to provide a simple functional classification of ventilator modes and addresses the key aspects of synchronized ventilation modes. The rationale for volume-targeted ventilation is presented, the available modes are described and the importance of the open-lung strategy is emphasized. The available literature on volume-targeted modalities is reviewed in detail and general recommendations for their clinical application are provided. Volume guarantee has been studied most extensively and shown to reduce excessively large tidal volumes, decrease incidence of inadvertent hyperventilation, reduce duration of mechanical ventilation and reduce proinflammatory cytokines. It remains to be seen whether the demonstrated short-term benefits translate into significant reduction in chronic lung disease. Avoidance of mechanical ventilation by means of early continuous positive airway pressure with or without surfactant administration may still be the most effective way to reduce the risk of lung injury. For babies who do require mechanical ventilation, the combination of volume-targeted ventilation, combined with the open-lung strategy appears to offer the best chance of reducing the risk of bronchopulmonary dysplasia.

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Randomized controlled trial of volume-targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy

Cited by 46 publications

References 30 publications

Mechanical Ventilation of the Premature Neonate

Mechanical Ventilation of the Premature Neonate

Lower back-up rates improve ventilator triggering during assist-control ventilation: a randomized crossover trial

State of the art in conventional mechanical ventilation

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