Improved oxygenation during synchronized intermittent mandatory ventilation in neonates with respiratory distress syndrome: A randomized, crossover study☆,☆☆,★
Section snippets
Patient population
Infants were eligible for study if their birth weight was less than 1750 gm, gestational age was <32 weeks, and chronologic age was <12 hours. All had radiographic evidence of respiratory distress syndrome, had an arterial line inserted for routine monitoring, were breathing spontaneously on a ventilator, and had an arterial/alveolar oxygen ratio <0.25. The ratio of arterial to alveolar partial pressure of oxygen was calculated with the fraction of inspired oxygen and the arterial oxygen and
RESULTS
Ten infants meeting initial entry criteria were enrolled in the study. The airway flow recording showed one infant to have a rate of asynchrony <10% during IMV, and he was therefore excluded from further study. The rate of synchrony achieved during SIMV was >98%.
Three paired comparisons of PaO2 and PaCO2 between IMV and SIMV were possible for each patient. Twenty-six comparisons were made in the nine infants who completed the study; one comparison was excluded because the ventilator settings
DISCUSSION
We demonstrated an improvement in Pao2 and a small increase in ventilation between IMV and SIMV in low birth weight infants with moderate to severe respiratory distress syndrome. A mean rate of asynchrony of 53% was seen during IMV despite what was thought to be optimal ventilator support based on gas exchange and no visible evidence that the infant was "fighting the ventilator." Asynchrony was essentially eliminated during SIMV.
Asynchrony has been associated with active expiration,2, 3 reduced
References (30)
- et al.
Interaction of spontaneous respiration with artificial ventilation in preterm babies
J PEDIATR
(1983) - et al.
Pancuronium prevents pneumothoraces in ventilated premature babies who actively expire against positive pressure ventilation
Lancet
(1984) The premature infant's respiratory response to mechanical ventilation
Early Hum Dev
(1988)- et al.
Acute cardiopulmonary effects of pancuronium bromide in mechanically ventilated newborn infants
J PEDIATR
(1984) - et al.
Causes of failure of neonatal patient- triggered ventilation
Early Hum Dev
(1990) - et al.
Patient initiated mechanical ventilation
- et al.
An active expiratory reflex in preterm ventilated infants
- et al.
Manipulation of ventilator settings to prevent active expiration against positive pressure inflation
Arch Dis Child
(1985) - et al.
Respiratory paralysis to improve oxygenation and mortality in large newborn infants with respiratory distress
J Pediatr Surg
(1979) - et al.
Muscle relaxation in mechanically ventilated infants
J PEDIATR
(1978)
Cerebral blood flow velocity variability in infants receiving assisted ventilation
Arch Dis Child
Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome
N Engl J Med
Fluctuating cerebral blood-flow velocity in respiratory distress syndrome
N Engl J Med
Synchronous mechanical ventilation of the neonate
Arch Dis Child
Synchronous mechanical ventilation of the infant with respiratory disease
Crit Care Med
Cited by (90)
Management of Extreme Prematurity (Manuscript for Seminars in Pediatric Surgery)
2022, Seminars in Pediatric SurgeryCitation Excerpt :Conventional mechanical ventilation is most often employed when intubation is required. Ventilation modes that allow for supported spontaneous breaths, such as synchronized intermittent mandatory ventilation (SIMV) or assist-control ventilation (A/C) are generally preferred for improved ventilatory synchrony, gas exchange, and patient comfort.29 Positive end-expiratory pressure (PEEP) is initially set at 5 cm H2O, and can be increased to prevent atelectasis.
Basic modes of synchronized ventilation
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionMECHANICAL VENTILATION IN THE EXTREME PREMATURE NEWBORN, WHERE WE ARE GOING?
2021, Revista Medica Clinica Las Condes“Current concepts in assisted mechanical ventilation in the neonate” - Part 2: Understanding various modes of mechanical ventilation and recommendations for individualized disease-based approach in neonates
2020, International Journal of Pediatrics and Adolescent MedicineCitation Excerpt :In essence, triggering tries to synchronize the baby’s initiation of breath with the beginning of the ventilator inflation, delivering the preset pressure or volume. Synchronization is one of the few advances in ventilation technology that has shown in studies to improve at least short-term outcomes [8–10]. Most ventilators use flow triggering, i.e., a small negative flow to the lungs generated by the baby triggers the ventilator (once the negative flow reaches the set trigger level).
Patient-Ventilator Interaction
2018, The Newborn Lung: Neonatology Questions and Controversies, Third EditionExtremely Low-Birth-Weight Infants
2018, Avery's Diseases of the Newborn: Tenth Edition
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From the Division of Neonatology, Department of Pediatrics, University of California, San Diego, School of Medicine
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Reprint requests: John P. Cleary, MD, The Med Center-Memorial, 119 Belmont St., Worcester, MA 01605.
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0022-3476/95/$3.00 + 0 9/23/60904