Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease

Andreas Schulze, Esther Rieger-Fackeldey, Tilo Gerhardt, Nelson R Claure, Ruth Everett-Thomas, Eduardo Bancalari

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

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 FiO2 (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.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalNeonatology
Volume92
Issue number1
DOIs
StatePublished - Jun 1 2007

Fingerprint

Interactive Ventilatory Support
Extremely Low Birth Weight Infant
Lung Diseases
Ventilation
Chronic Disease
Pressure
Mechanical Ventilators
Oxygen
Oximetry
Apnea
Birth Weight
Premature Infants
Cross-Over Studies
Gestational Age
Reading
Hemoglobins
Gases

Keywords

  • Apnea
  • Extremely low birth weight infant
  • Proportional assist ventilation

ASJC Scopus subject areas

  • Developmental Biology
  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease",
abstract = "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 FiO2 (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.",
keywords = "Apnea, Extremely low birth weight infant, Proportional assist ventilation",
author = "Andreas Schulze and Esther Rieger-Fackeldey and Tilo Gerhardt and Claure, {Nelson R} and Ruth Everett-Thomas and Eduardo Bancalari",
year = "2007",
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T1 - Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease

AU - Schulze, Andreas

AU - Rieger-Fackeldey, Esther

AU - Gerhardt, Tilo

AU - Claure, Nelson R

AU - Everett-Thomas, Ruth

AU - Bancalari, Eduardo

PY - 2007/6/1

Y1 - 2007/6/1

N2 - 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 FiO2 (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.

AB - 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 FiO2 (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.

KW - Apnea

KW - Extremely low birth weight infant

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