PT  - JOURNAL ARTICLE
AU  - Cornelia G de Waal
AU  - Ruud W van Leuteren
AU  - Frans H de Jongh
AU  - Anton H van Kaam
AU  - Gerard J Hutten
TI  - Patient-ventilator asynchrony in preterm infants on nasal intermittent positive pressure ventilation
AID  - 10.1136/archdischild-2018-315102
DP  - 2019 May 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F280--F284
VI  - 104
IP  - 3
4099  - http://fn.bmj.com/content/104/3/F280.short
4100  - http://fn.bmj.com/content/104/3/F280.full
SO  - Arch Dis Child Fetal Neonatal Ed2019 May 01; 104
AB  - Objective To describe the incidence of patient-ventilator asynchrony and different types of asynchrony in preterm infants treated with non-synchronised nasal intermittent positive pressure ventilation (nIPPV).Design An observational study was conducted including preterm infants born with a gestational age (GA) less than 32 weeks treated with non-synchronised nIPPV. During 1 hour, spontaneous breathing was measured with transcutaneous electromyography of the diaphragm simultaneous with ventilator inflations. An asynchrony index (AI), a percentage of asynchronous breaths, was calculated and the incidence of different types of inspiratory and expiratory asynchrony were reported.Results Twenty-one preterm infants with a mean GA of 26.0±1.2 weeks were included in the study. The mean inspiratory AI was 68.3%±4.7% and the mean expiratory AI was 67.1%±7.3%. Out of 5044 comparisons of spontaneous inspirations and mechanical inflations, 45.3% of the mechanical inflations occurred late, 23.3% of the mechanical inflations were early and 31.4% of the mechanical inflation were synchronous. 40.3% of 5127 expiratory comparisons showed an early termination of ventilator inflations, 26.7% of the mechanical inflations terminated late and 33.0% mechanical inflations terminated in synchrony with a spontaneous expiration. In addition, 1380 spontaneous breaths were unsupported and 611 extra mechanical inflations were delivered.Conclusion Non-synchronised nIPPV results in high patient-ventilator asynchrony in preterm infants during both the inspiratory and expiratory phase of the breathing cycle. New synchronisation techniques are urgently needed and should address both inspiratory and expiratory asynchrony.