Stress response and mode of ventilation in preterm infants

Abstract

Aim-To assess the change in stress response in preterm babies changed from patient triggered ventilation (PTV) to conventional mandatory ventilation (CMV) and vice versa; to determine outcome in relation to stress hormone concentrations. Methods-A randomised controlled study was conducted in two district general hospital neonatal intensive care units. Thirty babies, treated initially with CMV, were randomly assigned to remain on CMV or to change to PTV. A second group of 29 babies, treated initially with PTV, were randomly assigned to remain on PTV or to change to CMV. The babies were less than 32 weeks of gestation, ventilated within 72 hours of birth, with clinical and radiological features compatible with respiratory distress syndrome (RDS). Stress hormone concentrations and clinical distress score were measured before and 20 minutes after allocation of mode of ventilation. Results-Babies changed from CMV to PTV had significantly reduced adrenaline concentrations (median change −0.4 nmol/l) compared with those who remained on CMV. There was no increase in adrenaline in babies changed from PTV to CMV. There were no significant changes in noradrenaline concentrations or clinical distress score. Babies who died had significantly higher adrenaline and noradrenaline concentrations than those who survived. Conclusion-A change in mode of ventilation significantly reduces adrenaline concentrations. Raised catecholamine values are associated with a poor outcome. (Arch Dis Child Fetal Neonatal Ed 1998;78:F195-F198)

Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events

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

“…Increased tidal volume, more consistent flow-volume relationships, decreased work of breathing, reduced biochemical evidence of stress, and improvements in oxygenation have all been demonstrated in older neonates treated with synchronized ventilation. [9][10][11][12][13][14][20][21][22] However, no studies have addressed the impact of synchronization on the early effects of surfactant.…”

New modes of mechanical ventilation in the preterm newborn: evidence of benefit

“…Synchronous ventilation was shown to reduce markers of stress and blood pressure variability 12 15 17. Synchronised ventilation reduced breathing effort,15 16 but it did not seem to influence the metabolic demands associated with breathing 18.…”