Article Text

PDF
Assist control volume guarantee ventilation during surfactant administration
  1. K I Wheeler1,2,3,
  2. P G Davis1,3,4,
  3. C O F Kamlin1,3,
  4. C J Morley1,3
  1. 1
    Neonatal Services, The Royal Women’s Hospital (RWH), Melbourne, Australia
  2. 2
    Department of Physiology, Monash University, Melbourne, Australia
  3. 3
    Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia
  4. 4
    Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Kevin Wheeler, Neonatal Services, The Royal Women’s Hospital, Locked Bag 300, Cnr Grattan Street & Flemington Road. Parkville, VIC 3052, Australia; kevin.wheeler{at}thewomens.org.au

Abstract

Objective: To measure changes in ventilator parameters in preterm infants receiving surfactant during assist control volume guarantee (AC/VG) ventilation.

Methods: 22 preterm infants (up to 32 weeks’ gestation) receiving surfactant for respiratory distress syndrome were enrolled in a prospective study of ventilator parameters during AC/VG ventilation at a tertiary neonatal intensive care unit. Ventilator pressures, flow and tidal volume waveforms were recorded from the Dräger Babylog 8000 plus in real time, and compared to pre-surfactant measurements.

Results: Following surfactant administration, 21 of 22 babies experienced completely obstructed endotracheal gas flow. Peak inflation pressure (PIP) increased by a median (IQR) of 8 (4–10) cm H2O, and took 30–60 min to return to baseline. Inspired oxygen concentration was reduced from a median (IQR) of 39% (26%–44%) to 26% (21%–30%) in the first 5 min. The set maximum PIP (Pmax) limited the delivered PIP such that most babies received tidal volumes less than the target value (VTtarget) immediately following surfactant delivery. Four infants, in a subgroup of 11 infants where Pmax was set to less than 10 cm H2O above baseline PIP, were still receiving <90% of VTtarget 20 min post surfactant.

Conclusions: When giving surfactant during AC/VG ventilation, complete obstruction is common. PIPs increased and remain elevated for 30–60 min. The Pmax setting may restrict tidal volume delivery.

Statistics from Altmetric.com

Footnotes

  • Funding This research was funded by Australian National Health and Medical Research Council Program Grant no. 384100.

  • Competing interests None.

  • Ethics approval This study was approved by the RWH Research Committee.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Fantoms
    Ben Stenson