Effects of non-invasive pressure support ventilation (NI-PSV) on ventilation and respiratory effort in very low birth weight infants

Nabeel Ali, Nelson Claure, Ximena Alegria, Carmen D'Ugard, Roberto Organero, Eduardo Bancalari

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)704-710
Number of pages7
JournalPediatric pulmonology
Volume42
Issue number8
DOIs
StatePublished - Aug 1 2007

Keywords

  • Breathing effort
  • Continuous distending pressure
  • Non-invasive ventilation
  • Preterm infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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