TY - JOUR
T1 - Effects of non-invasive pressure support ventilation (NI-PSV) on ventilation and respiratory effort in very low birth weight infants
AU - Ali, Nabeel
AU - Claure, Nelson
AU - Alegria, Ximena
AU - D'Ugard, Carmen
AU - Organero, Roberto
AU - Bancalari, Eduardo
PY - 2007/8/1
Y1 - 2007/8/1
N2 - Background: Nasal continuous positive airway pressure (NCPAP) is used to provide support to non-intubated infants, but it often fails. Pressure support ventilation (PSV) is a mode of synchronized ventilation that can supplement the spontaneous breathing effort, but it is unknown if it is effective in non-intubated very low birth weight (VLBW) infants. Objectives: To compare the acute physiological effects of non-invasive PSV (NI-PSV) versus NCPAP on tidal volume (VT), minute ventilation (VE), gas exchange, breathing effort, and chest wall distortion in VLBW infants. Methods: Stable preterm infants of birth weight less 1,250 g were studied during consecutive 2 hr periods of NCPAP and NI-PSV in random sequence. VT, VE, and thoraco-abdominal synchrony were measured using respiratory inductance plethysmography. Breathing effort was measured by esophageal manometry. Gas exchange was measured by pulse oximetry and transcutaneous PCO2. Results: Fifteen infants of birth weight (mean ± SD) 808 ± 201 g and 25.9 ± 1.8 weeks gestational age were studied while on NCPAP 5.3 ± 0.6 cm H2O and on NI-PSV with 7.9 ± 1.3 cm H 2O above NCPAP of pressure support. There were no differences in VT, VE, PCO2 or hypoxemia episodes. Peak and minute inspiratory effort were significantly reduced in NI-PSV mode as compared to NCPAP. There was a significant reduction in indices of chest wall asynchrony in NI-PSV mode. Conclusion: When compared to NCPAP, NI-PSV did not increase minute ventilation, but it effectively unloaded the patient's respiratory pump as indicated by a lower inspiratory effort and reduced chest wall distortion.
AB - Background: Nasal continuous positive airway pressure (NCPAP) is used to provide support to non-intubated infants, but it often fails. Pressure support ventilation (PSV) is a mode of synchronized ventilation that can supplement the spontaneous breathing effort, but it is unknown if it is effective in non-intubated very low birth weight (VLBW) infants. Objectives: To compare the acute physiological effects of non-invasive PSV (NI-PSV) versus NCPAP on tidal volume (VT), minute ventilation (VE), gas exchange, breathing effort, and chest wall distortion in VLBW infants. Methods: Stable preterm infants of birth weight less 1,250 g were studied during consecutive 2 hr periods of NCPAP and NI-PSV in random sequence. VT, VE, and thoraco-abdominal synchrony were measured using respiratory inductance plethysmography. Breathing effort was measured by esophageal manometry. Gas exchange was measured by pulse oximetry and transcutaneous PCO2. Results: Fifteen infants of birth weight (mean ± SD) 808 ± 201 g and 25.9 ± 1.8 weeks gestational age were studied while on NCPAP 5.3 ± 0.6 cm H2O and on NI-PSV with 7.9 ± 1.3 cm H 2O above NCPAP of pressure support. There were no differences in VT, VE, PCO2 or hypoxemia episodes. Peak and minute inspiratory effort were significantly reduced in NI-PSV mode as compared to NCPAP. There was a significant reduction in indices of chest wall asynchrony in NI-PSV mode. Conclusion: When compared to NCPAP, NI-PSV did not increase minute ventilation, but it effectively unloaded the patient's respiratory pump as indicated by a lower inspiratory effort and reduced chest wall distortion.
KW - Breathing effort
KW - Continuous distending pressure
KW - Non-invasive ventilation
KW - Preterm infant
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U2 - 10.1002/ppul.20641
DO - 10.1002/ppul.20641
M3 - Article
C2 - 17595037
AN - SCOPUS:34547786511
VL - 42
SP - 704
EP - 710
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
SN - 8755-6863
IS - 8
ER -