Synchronized mechanical ventilation for respiratory support in newborn infants

Greenough, Anne; Dimitriou, Gabriel; Prendergast, Michael; Milner, Anthony

doi:10.1002/14651858.cd000456.pub3

Cited by 122 publications

(43 citation statements)

References 67 publications

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“…Several meta-analyses published since then have shown no significant difference in BPD rates between SIMV and HFOV, when HFOV was used as a primary mode of ventilation in preterm infants with RDS [9][10][11]. In patients failing conventional mechanical ventilation, high frequency ventilation may be used as a rescue mode.…”

Section: High Frequency Ventilationmentioning

confidence: 99%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia. Invasive VentilationBronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short-and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Noninvasive respiratory support modes, especially bilevel CPAP or SiPAP mode, have not been shown to impact BPD rate. However, use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants.

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Section: High Frequency Ventilationmentioning

confidence: 99%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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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: 85%

“…In a Cochrane review of synchronized ventilation modes, the duration of weaning (comparison 3.1) tended to be slightly shorter with AC mode rather than synchronized intermittent mandatory ventilation. 3 Although the difference was not statistically significant, the authors suggested AC, 'would seem the more desirable mode of weaning for preterm neonates. ' In a review article, Sinha and Donn 16 recommended during AC, clinicians wean infants by reducing using a BUR to 25-30 min À1 while reducing the PIP, aiming to maintain a tidal volume X4 ml kg À1 .…”

Section: Implications For Weaningmentioning

confidence: 95%

“…2 Triggered modes, compared with non-triggered modes, are associated with a reduction in air leak and duration of ventilation. 3 Assist-control (AC) mode, also referred to as synchronized intermittent-positive pressure ventilation or patient-triggered ventilation, aims to provide an inflation to support every spontaneous breath. Synchronized intermittent mandatory ventilation provides a fixed number of triggered inflations per minute.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Although removal of the flow sensor would reduce dead space, it prevents use of synchronized ventilation, a ventilatory strategy that has been shown to accelerate weaning in preterm infants. 11 This also disables volume monitoring, which is routinely used to target tidal volume. Synchronization and volume monitoring can also be achieved with the ventilator's internal flow sensors because these do not increase dead space.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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.

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Synchronized mechanical ventilation for respiratory support in newborn infants

Cited by 122 publications

References 67 publications

Non-Invasive Ventilation and Surfactant Therapy

Non-Invasive Ventilation and Surfactant Therapy

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

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

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