Volume Targeted Ventilation and High Frequency Ventilation as the Primary Modes of Respiratory Support for ELBW Babies: What Does the Evidence Say?

Ganguly, Abhrajit; Makkar, Abhishek; Sekar, Krishnamurthy

doi:10.3389/fped.2020.00027

Cited by 15 publications

(20 citation statements)

References 66 publications

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“…Theoretically, the PIP delivered by CMV may not be equivalent to the PIP generated by HFJV. 14 Given the difference between the two modes of ventilation, combining PIP data from CMV and HFJV may lead to bias. For this reason, we performed a subgroup analysis for CMV settings and another for HFJV settings.…”

Section: Discussionmentioning

confidence: 99%

Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures

Rubalcava

Norwitz

Kim

et al. 2022

World Jnl Ped Surgery

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BackgroundPatients with congenital diaphragmatic hernia (CDH) require invasive respiratory support and higher ventilator pressures may be associated with barotrauma. We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.MethodsWe retrospectively reviewed newborns born with CDH between 2014 and 2019 who developed a pneumothorax, and we matched these cases to patients with CDH without pneumothorax.ResultsTwenty-six patients were included (n=13 per group). The pneumothorax group required extracorporeal life support (ECLS) more frequently (85% vs 54%, p=0.04), particularly among type A/B defects (31% vs 7%, p=0.01). The pneumothorax group had higher positive end-expiratory pressure (PEEP) within 1 hour of birth (p=0.02), at pneumothorax diagnosis (p=0.003), and at ECLS (p=0.02). The pneumothorax group had a higher mean airway pressure (Paw) at birth (p=0.01), within 1 hour of birth (p=0.01), and at pneumothorax diagnosis (p=0.04). Using multiple logistic regression with cluster robust SEs, higher Paw (OR 2.2, 95% CI 1.08 to 3.72, p=0.03) and PEEP (OR 1.8, 95% CI 1.15 to 3.14, p=0.007) were associated with an increased risk of developing pneumothorax. There was no difference in survival (p=0.09).ConclusionsDevelopment of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP. A pneumothorax increases the likelihood of treated with ECLS, even with smaller defect.

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Section: Discussionmentioning

confidence: 99%

Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures

Rubalcava

Norwitz

Kim

et al. 2022

World Jnl Ped Surgery

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“…53 HFJV combines some of the benefits of tidal ventilation and HFOV where cycles of 4-11 Hz are pulsated with a high velocity through a cannula in tandem with conventional ventilation that maintains an open lung by applying an adequately preset PEEP and sigh breaths if necessary whereas exhalation is passive. 54, [55] HFJV was primary studied as a rescue treatment for pulmonary air leaks, but encouraging studies during the early surfactant era showed a reduction in BPD in infants with RDS compared with conventional ventilation (CV). 56,57 Since then, HFJV has become a first intention ventilatory strategy for infants of 22-27 weeks of GA in some centers [6,48].…”

Section: Invasive Ventilation and Caffeinementioning

confidence: 99%

Respiratory support of infants born at 22–24 weeks of gestational age

Norman

Jónsson

Wallström

et al. 2022

Seminars in Fetal and Neonatal Medicine

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“…However, only one of these 10 RCTs used a volume-targeted ventilation mode in the conventional treatment arm. Modern respirators have substantially improved regarding synchronization and tidal volume measurements; therefore, there is a need for RCTs comparing volume-targeted ventilation modes and HFOV [ 84 ].…”

Section: What Is the Evidence For?mentioning

confidence: 99%

“…As modern respirators have evolved in terms of synchronization and tidal volume measurements, a comparison between volume-targeted ventilation modes and HFOV might be more relevant to neonatologists in the 2020s [ 84 ]. In the absence of valid recent data and with relatively small differences from meta-analyses of RCTs performed in the last four decades, it is difficult to make clear recommendations.…”

Section: Recommendations For the Everyday Bpd Management Based On The Presented Evidencementioning

confidence: 99%

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

2021

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Background: Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD. Objective: The goal of our review is to summarize the evidence on these daily procedures and provide evidence-based recommendations for the management of BPD. Methods: We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy. Results: Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review. Discussion: There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only.

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Volume Targeted Ventilation and High Frequency Ventilation as the Primary Modes of Respiratory Support for ELBW Babies: What Does the Evidence Say?

Cited by 15 publications

References 66 publications

Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures

Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures

Respiratory support of infants born at 22–24 weeks of gestational age

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

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