Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease
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vor 17 Jahren
Background: Refinement of ventilatory techniques remains a
challenge given the persistence of chronic lung disease of preterm
infants. Objective: To test the hypothesis that proportional assist
ventilation ( PAV) will allow to lower the ventilator pressure at
equivalent fractions of inspiratory oxygen (FiO(2)) and arterial
hemoglobin oxygen saturation in ventilator-dependent extremely low
birth weight infants in comparison with standard patient-triggered
ventilation ( PTV). Methods: Design: Randomized crossover design.
Setting: Two level-3 university perinatal centers. Patients: 22
infants ( mean (SD): birth weight, 705 g ( 215); gestational age,
25.6 weeks ( 2.0); age at study, 22.9 days ( 15.6)). Interventions:
One 4- hour period of PAV was applied on each of 2 consecutive days
and compared with epochs of standard PTV. Results: Mean airway
pressure was 5.64 ( SD, 0.81) cm H2O during PAV and 6.59 ( SD,
1.26) cm H2O during PTV ( p < 0.0001), the mean peak inspiratory
pressure was 10.3 ( SD, 2.48) cm H2O and 15.1 ( SD, 3.64) cm H2O (
p < 0.001), respectively. The FiO(2) ( 0.34 (0.13) vs. 0.34 (
0.14)) and pulse oximetry readings were not significantly
different. The incidence of arterial oxygen desaturations was not
different ( 3.48 ( 3.2) vs. 3.34 ( 3.0) episodes/ h) but
desaturations lasted longer during PAV ( 2.60 ( 2.8) vs. 1.85 (
2.2) min of desaturation/ h, p = 0.049). PaCO2 measured
transcutaneously in a subgroup of 12 infants was similar. One
infant met prespecified PAV failure criteria. No adverse events
occurred during the 164 cumulative hours of PAV application.
Conclusions: PAV safely maintains gas exchange at lower mean airway
pressures compared with PTV without adverse effects in this
population. Backup conventional ventilation breaths must be
provided to prevent apnea-related desaturations. Copyright (c) 2007
S. Karger AG, Basel
challenge given the persistence of chronic lung disease of preterm
infants. Objective: To test the hypothesis that proportional assist
ventilation ( PAV) will allow to lower the ventilator pressure at
equivalent fractions of inspiratory oxygen (FiO(2)) and arterial
hemoglobin oxygen saturation in ventilator-dependent extremely low
birth weight infants in comparison with standard patient-triggered
ventilation ( PTV). Methods: Design: Randomized crossover design.
Setting: Two level-3 university perinatal centers. Patients: 22
infants ( mean (SD): birth weight, 705 g ( 215); gestational age,
25.6 weeks ( 2.0); age at study, 22.9 days ( 15.6)). Interventions:
One 4- hour period of PAV was applied on each of 2 consecutive days
and compared with epochs of standard PTV. Results: Mean airway
pressure was 5.64 ( SD, 0.81) cm H2O during PAV and 6.59 ( SD,
1.26) cm H2O during PTV ( p < 0.0001), the mean peak inspiratory
pressure was 10.3 ( SD, 2.48) cm H2O and 15.1 ( SD, 3.64) cm H2O (
p < 0.001), respectively. The FiO(2) ( 0.34 (0.13) vs. 0.34 (
0.14)) and pulse oximetry readings were not significantly
different. The incidence of arterial oxygen desaturations was not
different ( 3.48 ( 3.2) vs. 3.34 ( 3.0) episodes/ h) but
desaturations lasted longer during PAV ( 2.60 ( 2.8) vs. 1.85 (
2.2) min of desaturation/ h, p = 0.049). PaCO2 measured
transcutaneously in a subgroup of 12 infants was similar. One
infant met prespecified PAV failure criteria. No adverse events
occurred during the 164 cumulative hours of PAV application.
Conclusions: PAV safely maintains gas exchange at lower mean airway
pressures compared with PTV without adverse effects in this
population. Backup conventional ventilation breaths must be
provided to prevent apnea-related desaturations. Copyright (c) 2007
S. Karger AG, Basel
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