Proportional assist ventilation decreases thoracoabdominal asynchrony and chest wall distortion in preterm infants

G. Musante, A. Schulze, T. Gerhardt, Ruth Everett-Thomas, Nelson R Claure, P. Schaller, Eduardo Bancalari

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Thoracoabdominal asynchrony (TAA) and chest wall distortion (CWD) are commonly seen in preterm infants secondary to a highly compliant rib cage and poor compensation of distorting forces by inspiratory rib cage muscles. Continuous positive airway pressure (CPAP) reduces TAA and CWD by stenting the chest wall. We hypothesized that application of positive airway pressure only during inspiration and in proportion to an infant's inspiratory effort should have a similar but more pronounced effect than CPAP alone. A ventilator providing airway pressure changes in proportion to flow and volume generated by an infant (proportional assist ventilation) was used to unload the respiratory pump during inspiration. Ten preterm infants were studied [birth weight, 745 (635-1175) g; gestational age, 26.5 (24-31) wk; postnatal age 3 (1-7) d; medium (range)]. TAA and CWD were determined by respiratory inductive plethysmography. TAA was expressed as the phase angle between the rib cage and abdominal motion and CWD as the total compartmental displacement ratio. In addition, we measured tidal volume with a pneumotachograph and esophageal and airway pressure deflections with pressure transducers. Measurements were obtained during alternating periods of CPAP and two different degrees of support (Gain 1 = 1.09 ± 0.68, Gain 2 = 1.84 ± 0.84 cm H2O/mL) that were provided by a proportional assist ventilator. Phase angle and the total compartmental displacement ratio decreased with increasing gain compared with CPAP alone. Peak airway pressure increased from 0.6 to 3.8 to 7.6 cm H2O above positive end-expiratory pressure (PEEP) with CPAP, Gain 1, and Gain 2, respectively, as tidal volume increased from 2.8 to 4.1 to 4.7 mL/kg. Esophageal pressure changes decreased only little with increasing gain. Chest wall excursion increased and abdominal movement decreased, indicating a redistribution of tidal volume between chest and abdomen. We conclude that proportional assist ventilation reduces TAA and CWD by generating a small increase in airway pressure that occurs in synchrony and in proportion to each inspiratory effort.

Original languageEnglish
Pages (from-to)175-180
Number of pages6
JournalPediatric Research
Volume49
Issue number2
StatePublished - Feb 15 2001

Fingerprint

Interactive Ventilatory Support
Thoracic Wall
Premature Infants
Continuous Positive Airway Pressure
Pressure
Tidal Volume
Mechanical Ventilators
Pressure Transducers
Plethysmography
Positive-Pressure Respiration
Abdominal Wall
Birth Weight
Abdomen
Gestational Age
Thorax
Muscles

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Proportional assist ventilation decreases thoracoabdominal asynchrony and chest wall distortion in preterm infants. / Musante, G.; Schulze, A.; Gerhardt, T.; Everett-Thomas, Ruth; Claure, Nelson R; Schaller, P.; Bancalari, Eduardo.

In: Pediatric Research, Vol. 49, No. 2, 15.02.2001, p. 175-180.

Research output: Contribution to journalArticle

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