Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates

Bernstein, Graham; Mannino, Frank L.; Heldt, Gregory P.; Callahan, Janice D.; Bull, Dale; Sola, Augusto; Ariagno, Ronald L.; Hoffman, Gale L.; Frantz, Ivan D.; B, Troche; Roberts, John L.; Cruz, Teddy V. Dela; Costa, Edward

doi:10.1016/s0022-3476(96)70354-2

Cited by 125 publications

(57 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Amongst that subset, those supported by SIMV had a shorter duration of ventilation (p=0.02) but had similar rates of death, oxygen dependency at 28 days and airleaks to the SIMV group [2].…”

Section: Discussionmentioning

confidence: 95%

“…Only 15 infants born at term (all with meconium aspiration syndrome) were included [3]. In the other [2], 327 infants were randomised to SIMV or IMV. Ninety-three infants with a birth weight greater than 2 k and a mean gestational age 36 weeks and the study was adequately powered for subgroup analysis with respect to the oxygenation index and the incidence of airleaks.…”

Section: Discussionmentioning

confidence: 99%

“…In our experience it is rare to see RDS at or near term, but similarly our study included infants with TTN and MAS. We compared VTV to PLV rather than a triggered mode, as no RCT has demonstrated better outcomes for triggered modes with regard to the duration of ventilation or need for reintubation in at or near term born infants [2,3]. Similar numbers of infants in each of the randomised arms received intravenous morphine, thus it seems unlikely this influenced the TAA results.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Volume-targeted versus pressure-limited ventilation in infants born at or near term

et al. 2015

View full text Add to dashboard Cite

Our aims were to determine whether volume targeted ventilation (VTV) or pressure limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoraco-abdominal asynchrony (TAA) and associated with fewer hypocarbic episodes.Infants born at >34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age 39 (range 34-42) weeks were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5-312 hours (VTV) versus 33.5, 1.312 hours (PLV)) p=0.461. There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0-8) in the VTV group versus 4 (range 1-13) in the PLV group (p=0.005). Conclusions:In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation, but was associated with significantly fewer hypocarbic episodes.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Volume-targeted versus pressure-limited ventilation in infants born at or near term

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Synchronized modalities such as assist/control and synchronized intermittent mandatory ventilation (SIMV) have led to improved tidal volume (V T ) delivery and faster weaning. [1][2][3][4][5] In most neonatal ventilators synchronization and volume monitoring is achieved by the use of mainstream flow sensors. Although these have a relatively small dead space volume, they can produce rebreathing of exhaled gas leading to increased alveolar and arterial carbon dioxide (CO 2 ) in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants.Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705 ± 158 g, age: 31 ± 186 days, SIMV rate: 25 ± 8 breaths min -1 , peak inspiratory pressure 18±2 cm H 2 O, positive end-expiratory pressure: 5 ± 0.5 cm H 2 O, pressure support: 9 ± 3 cm H 2 O, fraction of inspired oxygen: 34 ± 6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min -1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector.Result: Transcutaneous CO 2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space.Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

show abstract

“…This mode of ventilation has been shown to reduce the incidence of BPD from 72% to 47% in infants less than 1000 g at birth. 10 Asynchrony of spontaneous and ventilator breaths is associated with decreased oxygenation, increased barotrauma, and an increased need for sedation. 11 A meta-analysis comparing patient-triggered ventilation/SIMV to CMV demonstrated a shorter duration of mechanical ventilation without a significant reduction in BPD.…”

Section: Introductionmentioning

confidence: 99%

The Sy-Fi Study: A Randomized Prospective Trial of Synchronized Intermittent Mandatory Ventilation Versus a High-Frequency Flow Interrupter in Infants Less Than 1000 G

2003

View full text Add to dashboard Cite

Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates

Cited by 125 publications

References 43 publications

Volume-targeted versus pressure-limited ventilation in infants born at or near term

Volume-targeted versus pressure-limited ventilation in infants born at or near term

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

The Sy-Fi Study: A Randomized Prospective Trial of Synchronized Intermittent Mandatory Ventilation Versus a High-Frequency Flow Interrupter in Infants Less Than 1000 G

Contact Info

Product

Resources

About