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Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants.
J Perinatol. 2005 Jun; 25(6):412-6.JP

Abstract

BACKGROUND

During weaning of synchronized intermittent mandatory rate in preterm infants, the spontaneous breaths must overcome the resistance of the endotracheal tube and the disease-induced respiratory loads. Pressure Support (PS) can be used as an adjunct to synchronized intermittent mandatory ventilation (SIMV) to partially unload the spontaneous breaths.

OBJECTIVE

To evaluate the effects of two levels of PS as an adjunct to SIMV on gas exchange and breathing effort during an acute reduction in SIMV rate in preterm infants.

METHODS

In all, 15 infants (birth weight 793 +/- 217 g, gestational age 26.4 +/- 1.5 weeks, postnatal age 15 +/- 16 days). Ventilatory support consisted of SIMV with peak inspiratory pressure (PTP) 16.3 +/- 1.3 cmH(2)O, positive end-expiratory pressure (PEEP) 4.3 +/- 0.6 cmH(2)O, and fraction of inspired oxygen (FiO(2)) 0.26 +/- 0.06. Infants were studied during four 30-minute periods: Two baseline SIMV periods and two periods of SIMV plus PS, in random order. During SIMV + PS, SIMV rate was lowered by 10 breaths per minute (b/minute) and PS was set at 3 and 6 cmH(2)O (SIMV+PS3 and SIMV + PS6, respectively).

RESULTS

SIMV rate was reduced during SIMV + PS from 21.4 +/- 6.6 to 11.4 +/- 6.6 b/minute. Arterial oxygen saturation, transcutaneous carbon dioxide tension and FiO(2) remained unchanged. Minute ventilation, total respiratory rate and mean airway pressure were higher during SIMV + PS. Per-breath inspiratory effort was lower during SIMV + PS and this was more striking during SIMV + PS6. Spontaneous inspiratory effort per minute increased during SIMV + PS3, but this increase was averted during SIMV + PS6.

CONCLUSION

Assistance of the spontaneous breaths with pressure support maintained gas exchange. PS of 6 cm H(2)O prevented an increase in breathing effort during an acute 50% reduction in SIMV rate.

Authors+Show Affiliations

Osorio W
Division of Neonatology, Department of Pediatrics, University of Miami School of Medicine, FL, USA.
Claure N
No affiliation info available
D'Ugard C
No affiliation info available
Athavale K
No affiliation info available
Bancalari E
No affiliation info available

MeSH

HumansInfant, NewbornInfant, PrematureIntermittent Positive-Pressure VentilationPressureRespiratory InsufficiencyVentilator Weaning

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15843812

Clinical Trial Links

Flow-cycled Ventilation in Preterm Infants

Citation

Osorio, Waldo, et al. "Effects of Pressure Support During an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants." Journal of Perinatology : Official Journal of the California Perinatal Association, vol. 25, no. 6, 2005, pp. 412-6.
Osorio W, Claure N, D'Ugard C, et al. Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants. J Perinatol. 2005;25(6):412-6.
Osorio, W., Claure, N., D'Ugard, C., Athavale, K., & Bancalari, E. (2005). Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants. Journal of Perinatology : Official Journal of the California Perinatal Association, 25(6), 412-6.
Osorio W, et al. Effects of Pressure Support During an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants. J Perinatol. 2005;25(6):412-6. PubMed PMID: 15843812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of pressure support during an acute reduction of synchronized intermittent mandatory ventilation in preterm infants. AU - Osorio,Waldo, AU - Claure,Nelson, AU - D'Ugard,Carmen, AU - Athavale,Kamlesh, AU - Bancalari,Eduardo, PY - 2005/4/22/pubmed PY - 2005/9/21/medline PY - 2005/4/22/entrez SP - 412 EP - 6 JF - Journal of perinatology : official journal of the California Perinatal Association JO - J Perinatol VL - 25 IS - 6 N2 - BACKGROUND: During weaning of synchronized intermittent mandatory rate in preterm infants, the spontaneous breaths must overcome the resistance of the endotracheal tube and the disease-induced respiratory loads. Pressure Support (PS) can be used as an adjunct to synchronized intermittent mandatory ventilation (SIMV) to partially unload the spontaneous breaths. OBJECTIVE: To evaluate the effects of two levels of PS as an adjunct to SIMV on gas exchange and breathing effort during an acute reduction in SIMV rate in preterm infants. METHODS: In all, 15 infants (birth weight 793 +/- 217 g, gestational age 26.4 +/- 1.5 weeks, postnatal age 15 +/- 16 days). Ventilatory support consisted of SIMV with peak inspiratory pressure (PTP) 16.3 +/- 1.3 cmH(2)O, positive end-expiratory pressure (PEEP) 4.3 +/- 0.6 cmH(2)O, and fraction of inspired oxygen (FiO(2)) 0.26 +/- 0.06. Infants were studied during four 30-minute periods: Two baseline SIMV periods and two periods of SIMV plus PS, in random order. During SIMV + PS, SIMV rate was lowered by 10 breaths per minute (b/minute) and PS was set at 3 and 6 cmH(2)O (SIMV+PS3 and SIMV + PS6, respectively). RESULTS: SIMV rate was reduced during SIMV + PS from 21.4 +/- 6.6 to 11.4 +/- 6.6 b/minute. Arterial oxygen saturation, transcutaneous carbon dioxide tension and FiO(2) remained unchanged. Minute ventilation, total respiratory rate and mean airway pressure were higher during SIMV + PS. Per-breath inspiratory effort was lower during SIMV + PS and this was more striking during SIMV + PS6. Spontaneous inspiratory effort per minute increased during SIMV + PS3, but this increase was averted during SIMV + PS6. CONCLUSION: Assistance of the spontaneous breaths with pressure support maintained gas exchange. PS of 6 cm H(2)O prevented an increase in breathing effort during an acute 50% reduction in SIMV rate. SN - 0743-8346 UR - https://www.unboundmedicine.com/medline/citation/15843812/Effects_of_pressure_support_during_an_acute_reduction_of_synchronized_intermittent_mandatory_ventilation_in_preterm_infants_ DB - PRIME DP - Unbound Medicine ER -