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Patient triggered ventilation in neonatal respiratory distress syndrome
  1. Intensive Care Units
  2. Great Ormond Street Hospital
  3. London WC1N 3JH, UK

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Editor—Baumer reports the results of a large multicentre study comparing the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV).1There appears to be no benefit from PTV compared with IMV in death rate, development of chronic lung disease, pneumothorax rates, and cerebral ultrasound abnormality. In addition, because of an increased trend toward a higher pneumothorax rate, Baumer concludes that, at present, PTV delivered with either the SLE 2000 or the Dräger babylog 8000 ventilators cannot be recommended for infants of less than 28 weeks gestation with respiratory distress syndrome (RDS).

However, we are concerned that this may be a premature conclusion given the significant difference in PTV delivered by the two main ventilators used and the potential heterogeneity of clinical practice within the different centres involved, despite agreed ventilation protocols. Dimitriou et al 2 showed that neonates and infants trigger a significantly lower proportion of breaths using the SLE 2000, an airway pressure triggered ventilator, compared with the Dräger babylog 8000, an airflow triggered ventilator that provides synchronised intermittent positive pressure ventilation (SIPPV). Attempts to optimise the trigger rate of the SLE 2000 ventilator by increasing pressure sensitivity often results in autotriggering as discussed by Baumer. Therefore the PTV modes of the two ventilators are substantially different. This prompts us to ask whether the findings of this multicentre study are only applicable to PTV provided by the SLE 2000? Would there have been a different outcome if all the triggered babies had received SIPPV?

It is not known how many of the 40/213 babies of less than 28 weeks gestation who had pneumothoraces were receiving SIPPV. As only 11% (52/465) of all triggered babies ever received SIPPV, we surmise that very few of the 40 were ventilated in this way. Is it fair to conclude …

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