Abstract
OBJECTIVE:
To compare the effect of combining assist/control with volume-guarantee (AC+VG) vs synchronized intermittent mandatory ventilation with VG (SIMV+VG) on tidal volume (VT), peak inspiratory pressure (PIP), mean airway pressure (MAP), respiratory rate, heart rate, oxygen saturation (SpO2), and minute volume (MV) in preterm infants.
STUDY DESIGN:
A total of 12 infants were randomized to receive AC+VG, followed by SIMV+VG, or the opposite sequence for four alternating 2-hour periods.
RESULTS:
Airway pressure of machine breaths was higher during SIMV. MV and VTe were similar, but more variable during synchronized intermittent mandatory ventilation. The VTe of unsupported breaths during SIMV was lower than machine breaths of SIMV and AC. There was more tachycardia and tachypnea with a lower and more variable SpO2 during SIMV.
CONCLUSIONS:
SIMV+VG is associated with higher work of breathing indicated by tachycardia, tachypnea and lower SpO2 compared to AC+VG. VG appears to be more effective when combined with AC than with SIMV.
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References
Donn SM, Sinha SK . Controversies in patient-triggered ventilation. Clin Perinatol 1998;25:49–61.
Perlman JM, McMenamin JB, Volpe JJ . Fluctuating cerebral blood flow velocity in respiratory distress syndrome: relationship to subsequent development of intraventricular hemorrhage. N Engl J Med 1983;309:204–209.
Banner MJ, Kirby RR, MacIntyre NR . Patient and ventilator work of breathing and ventilatory muscle loads at different levels of pressure support ventilation. Chest 1991;100:531–533.
Amato MBP, Barbas CSV, Bonassa J, et al. Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest 1992;102:1225–1234.
Guliani R, Mascia L, Recchia F, et al. Patient–ventilator interaction during synchronized intermittent mandatory ventilation. Am J Respir Crit Care Med 1995;151:1–9.
Tokioa H, Kinjo M, Hirakawa M . The effectiveness of pressure support ventilation for mechanical ventilatory support in children. Anesthesiology 1993;78:880–884.
El-Khatib MF, Chatburn RL, Potts DL, et al. Mechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during pressure-support ventilation. Crit Care Med 1994;22:1942–1948.
Donn SM, Nicks JJ, Becker MA . Flow-synchronized ventilation of preterm infants with respiratory distress syndrome. J Perinatol 1994;14:90–94.
Jarreau PH, Moriette G, Mussat P, et al. Patient-triggered ventilation decreases the work of breathing in neonates. Am J Respir Crit Care Med 1996;153:1176–1181.
Smith KM, Wahlig TM, Bing DR, Georgioff MK, Bores SJ, Mammel MC . Lower respiratory rates without decreases in oxygen consumption during neonatal synchronized intermittent mandatory ventilation. Intensive Care Med 1997;23:463–468.
Cleary JP, Bernstein G, Mannino FL, Heldt GP . Improved oxygenation during synchronized intermittent mandatory ventilation in neonates with respiratory distress syndrome: a randomized, crossover study. J Pediatr 1995;126:407–411.
Bernstein G, Mannino FL, Heldt GP, et al. Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. J Pediatr 1996;128:453–463.
Chan V, Greenough A . Comparison of weaning by patient triggered ventilation or synchronous mandatory intermittent ventilation. Acta Paediatr 1994;83:335–337.
Dimitriou G, Greenough A, Giffin FJ, Chan V . Synchronous intermittent mandatory ventilation modes versus patient triggered ventilation during weaning. Arch Dis Child 1995;72:F188–F190.
Hummler H, Gerhardt T, Gonzalez A, Claure N, Everett R, Bancalari E . Influence of different methods of synchronized mechanical ventilation on ventilation, gas exchange, patient effort, and blood pressure fluctuations in premature neonates. Pediatr Pulmonol 1996;22:305–313.
Mrozek JD, Bendel-Stenzel EM, Meyers PA, Bing DR, Connett JE, Mammel MC . Randomized controlled trial of volume-targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy. Pediatr Pulmonol 2000;29:11–18.
Dreyfuss D, Saumon G . Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis 1993;148:1194–1203.
Dreyfuss D, Saumon G . Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998;157:294–323.
Cheema IU, Ahluwalia JS . Feasibility of tidal volume-guided ventilation in newborn infants: a randomized, crossover trial using the volume guarantee modality. Pediatrics 2001;107(6):1323–1328.
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(3):529–533.
Keszler M, Abubakar K . Volume guarantee: stability of tidal volume and incidence of hypocarbia. Pediatr Pulmonol 2004;38(3):240–245.
Abubakar KM, Keszler M . Patient–ventilator interactions in new modes of patient-triggered ventilation. Pediatr Pulmonol 2001;32(1):71–75.
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Abubakar, K., Keszler, M. Effect of Volume Guarantee Combined with Assist/Control vs Synchronized Intermittent Mandatory Ventilation. J Perinatol 25, 638–642 (2005). https://doi.org/10.1038/sj.jp.7211370
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DOI: https://doi.org/10.1038/sj.jp.7211370
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