Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

A. Estay, Nelson R Claure, C. D'Ugard, R. Organero, Eduardo Bancalari

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants. Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705±158 g, age: 31±186 days, SIMV rate: 25±8 breaths min-1, peak inspiratory pressure 18±2 cm H2O, positive end-expiratory pressure: 50.5 cm H 2 O, pressure support: 93 cm H2O, fraction of inspired oxygen: 34±6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min-1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector. Result: Transcutaneous CO2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space. Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

Original languageEnglish
Pages (from-to)479-483
Number of pages5
JournalJournal of Perinatology
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2010

Fingerprint

Weaning
Premature Infants
Ventilation
Ventilator Weaning
Gases
Pressure
Positive-Pressure Respiration
Tidal Volume
Birth Weight
Gestational Age
Oxygen

Keywords

  • dead space
  • flow sensor
  • premature infant
  • rebreathing
  • SIMV

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants. / Estay, A.; Claure, Nelson R; D'Ugard, C.; Organero, R.; Bancalari, Eduardo.

In: Journal of Perinatology, Vol. 30, No. 7, 01.07.2010, p. 479-483.

Research output: Contribution to journalArticle

@article{fcbcfc2516964a92a30f68a12d900cfd,
title = "Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants",
abstract = "Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants. Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705±158 g, age: 31±186 days, SIMV rate: 25±8 breaths min-1, peak inspiratory pressure 18±2 cm H2O, positive end-expiratory pressure: 50.5 cm H 2 O, pressure support: 93 cm H2O, fraction of inspired oxygen: 34±6{\%}) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min-1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector. Result: Transcutaneous CO2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space. Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.",
keywords = "dead space, flow sensor, premature infant, rebreathing, SIMV",
author = "A. Estay and Claure, {Nelson R} and C. D'Ugard and R. Organero and Eduardo Bancalari",
year = "2010",
month = "7",
day = "1",
doi = "10.1038/jp.2009.187",
language = "English",
volume = "30",
pages = "479--483",
journal = "Journal of Perinatology",
issn = "0743-8346",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

AU - Estay, A.

AU - Claure, Nelson R

AU - D'Ugard, C.

AU - Organero, R.

AU - Bancalari, Eduardo

PY - 2010/7/1

Y1 - 2010/7/1

N2 - Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants. Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705±158 g, age: 31±186 days, SIMV rate: 25±8 breaths min-1, peak inspiratory pressure 18±2 cm H2O, positive end-expiratory pressure: 50.5 cm H 2 O, pressure support: 93 cm H2O, fraction of inspired oxygen: 34±6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min-1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector. Result: Transcutaneous CO2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space. Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

AB - Objective: A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants. Study Design: Twelve preterm infants (gestational age 25±2 weeks, birth weight 705±158 g, age: 31±186 days, SIMV rate: 25±8 breaths min-1, peak inspiratory pressure 18±2 cm H2O, positive end-expiratory pressure: 50.5 cm H 2 O, pressure support: 93 cm H2O, fraction of inspired oxygen: 34±6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min-1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector. Result: Transcutaneous CO2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space. Conclusion: SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

KW - dead space

KW - flow sensor

KW - premature infant

KW - rebreathing

KW - SIMV

UR - http://www.scopus.com/inward/record.url?scp=77954244183&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954244183&partnerID=8YFLogxK

U2 - 10.1038/jp.2009.187

DO - 10.1038/jp.2009.187

M3 - Article

VL - 30

SP - 479

EP - 483

JO - Journal of Perinatology

JF - Journal of Perinatology

SN - 0743-8346

IS - 7

ER -