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The effect of two levels of pressure support ventilation on tidal volume delivery and minute ventilation in preterm infants
  1. S Gupta1,
  2. S K Sinha2,
  3. S M Donn3
  1. 1
    University Hospital of North Tees, Stockton-on-Tees, UK
  2. 2
    University of Durham, The James Cook University Hospital, Middlesbrough, UK
  3. 3
    Division of Neonatal-Perinatal Medicine, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, Michigan, USA;
  1. Sunil K Sinha, Professor of Paediatrics, University of Durham, Consultant in Paediatrics and Neonatal Medicine, The James Cook University Hospital, Middlesbrough, UK; Sunil.sinha{at}


Objective: To study the effect of different levels of pressure support ventilation (PSV) on respiratory parameters in preterm infants during the weaning phase of mechanical ventilation.

Design/methods: In this quasi-experimental crossover study, a total of 19 154 breaths were analysed from 10 ventilated infants of <32 weeks’ gestation. Breath-to-breath data on minute ventilation, tidal volume, respiratory rate, peak inspiratory pressure and mean airway pressure were collected during three study epochs: synchronised intermittent mandatory ventilation (SIMV) alone, SIMV with partial PSV (PSmin), and SIMV with full PSV (PSmax). PSmin was set to provide an exhaled tidal volume (VTe) between 2.5–4 ml/kg and PSmax 5–8 ml/kg VTe. Statistical analyses were performed using analysis of variance (ANOVA) for repeated measures.

Results: The addition of full PSV (PSmax) was associated with a significant increase in total minute ventilation as compared with SIMV alone (392 ml/kg/min vs 270 ml/kg/min, respectively; p<0.05). This difference in minute ventilation was still present when PSmin was used (332 ml/kg/min as compared with 270 ml/kg/min in SIMV; p<0.05). There was also a concomitant decrease in the respiratory rate with both PSmax (59 breaths per minute) and PSmin (65 breaths per minute) compared with SIMV alone (72 breaths per min) (p<0.05).

Conclusions: Pressure support ventilation increases total minute ventilation and stabilises breathing in proportion to the level of pressure support used. This may be advantageous and provide a useful ventilation strategy for use during weaning stages of mechanical ventilation in preterm infants.

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  • Competing interests: None.

  • Patient consent: Written informed consent was obtained from each parent prior to study entry.