Abstract
OBJECTIVE:
To evaluate the feasibility of using the pressure support ventilation with volume guarantee (PSV-VG) as an initial ventilatory mode in preterm infants with respiratory distress syndrome (RDS) after surfactant treatment to achieve accelerated weaning of peak inspiratory pressure (PIP) and mean airway pressure (MAP).
STUDY DESIGN:
Initial 24-hour ventilatory parameters were compared in two groups of preterm infants managed by PSV-VG and the synchronized intermittent mandatory ventilation (SIMV) mode in a randomized controlled pilot study after surfactant treatment for RDS. A total of 16 babies were randomized to PSV-VG (1198±108 g [mean±SEM]; 27.9±0.6 weeks) and 18 babies to SIMV (birth weight 1055±77 g; gestational age 27.4±0.5 weeks). Repeated measures analysis of variance was used to compare serial values of PIP and MAP in the two groups.
RESULTS:
The PIP and MAP decreased over time (p<0.001) during the first 24 hours after surfactant administration in both groups but the decrease in MAP was faster in the SIMV group compared to PSV-VG group (p=0.035). The median numbers of blood gases during the first 24 hours were four and two in the SIMV and PSV-VG groups, respectively (p<0.001). The overall outcomes were not significantly different between the two groups.
CONCLUSION:
PSV-VG did not offer any ventilatory advantage over SIMV in the initial management of surfactant-treated premature newborns with RDS except for minimizing the number of blood gases.
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References
Davis JM, Veness-Meehan K, Notter RH, Bhutani VK, Kendig JW, Shapiro DL . Changes in pulmonary mechanics after the administration of surfactant to infants with respiratory distress syndrome. N Eng J Med 1988;319:476–479.
Goldsmith LS, Greenspan JS, Rubenstein SD, Wolfson MR, Shaffer TH . Immediate improvement in lung volume after exogenous surfactant: alveolar recruitment versus increased distension. J Pediatr 1991;119:424–428.
Farstad T, Bratlid D . Pulmonary effects after surfactant treatment in premature infants with severe respiratory distress syndrome. Biol Neonate 1995;68:246–253.
Dreyfuss D, Sauman G . Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Dis 1998;157:294–323.
Dreyfuss D, Sauman G . Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am J Respir Dis 1993;148:1194–1203.
Laffey JG, Kavanger BP . Hypocapnia. N Engl J Med 2002;347:43–53.
Donn SM, Sinha SK . Controversies in patient-triggered ventilation. Clin Perinatol 1998;25:49–61.
Donn SM, Sinha SK . Newer modes of mechanical ventilation for the neonate. Curr Opin Pediatr 2001;13:99–103.
Abubaker KM, Keszler M . Patient–ventilator interactions in new modes of patient-triggered ventilation. Pediatr Pulmonol 2001;32:71–75.
Thomas JR, Nelson JK, Thomas KT . A generalized rank-order method for nonparametric analysis of data from exercise science: a tutorial. Res Q Exercise Sport 1999;70:11–23.
Sinha SK, Donn SM, Gavey J, McCarty M . Randomised trial of volume controlled versus time cycled, pressure limited ventilation in preterm infants with respiratory distress syndrome. Arch Dis Child 1997;77:F202–F205.
Herrera CM, Gerhardt T, Claure N, et al. Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure. Pediatrics 2002;110:529–533.
Cheema IU, Ahluwalia JS . Feasibility of tidal volume — guided ventilation in newborn infants: a randomized, crossover trial using volume guarantee modality. Pediatrics 2001;107:1323–1328.
Lista G, Marangione P, Azzali A, Castoldi F, Pogliani L, Compagnoni G . The “guaranteed volume” in pressure support ventilation reduces the risk of barotrauma in premature children with severe respiratory syndrome. Acta Biomed Ateneo Parmense 2000;71(Suppl 1):453–456.
Olsen SL, Thibeault DW, Truog WE . Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation. J Perinatol 2002;22:461–466.
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The study was supported in part by a fellowship grant “Advancing Newborn Medicine” to Suhas M. Nafday from Forest Pharmaceuticals Inc. No products from the company were used during this study.
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Nafday, S., Green, R., Lin, J. et al. Is there an Advantage of Using Pressure Support Ventilation with Volume Guarantee in the Initial Management of Premature Infants with Respiratory Distress Syndrome? A pilot study. J Perinatol 25, 193–197 (2005). https://doi.org/10.1038/sj.jp.7211233
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DOI: https://doi.org/10.1038/sj.jp.7211233
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