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Synchronized mechanical ventilation for respiratory support in newborn infants
A Greenough1, A D Milner, G Dimitriou
1Dept of Child Health, King's College School of Medicine and Dentistry, Bessemer Road, London, UK, SE5 9PJ. a.greenough@kcl.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Synchronized mechanical ventilation, including high frequency positive pressure ventilation (HFPPV) and triggered ventilation (patient triggered ventilation/synchronous intermittent mandatory ventilation), reduces airleak and ventilation duration in neonates compared to conventional methods.
Area of Science:
- Neonatal respiratory support
- Mechanical ventilation strategies
- Clinical trial meta-analysis
Background:
- Synchronous ventilation aligns positive pressure with spontaneous breaths, potentially improving gas exchange and reducing lung injury.
- This approach aims to lower peak pressures, decreasing risks of barotrauma, airleak, and chronic lung disease in neonates.
- Methods to achieve synchronous ventilation include manipulating conventional settings or using patient-assisted modes.
Purpose of the Study:
- To compare the efficacy of synchronized mechanical ventilation (HFPPV, PTV/SIMV) against conventional ventilation (CMV) in neonates.
- To evaluate and compare different types of triggered ventilation (PTV vs. SIMV).
Main Methods:
- Systematic literature search of perinatal databases and clinical trials.
- Included randomized or quasi-randomized trials comparing synchronized ventilation modes (HFPPV, PTV/SIMV) with CMV in neonates.
- Analyzed outcomes: mortality, airleaks, intraventricular hemorrhage, chronic lung disease, and duration of ventilation/weaning.
Main Results:
- High frequency positive pressure ventilation (HFPPV) significantly reduced the risk of airleaks compared to conventional mechanical ventilation (CMV).
- Patient triggered ventilation/synchronous intermittent mandatory ventilation (PTV/SIMV) resulted in a shorter duration of ventilation compared to CMV.
- Patient triggered ventilation (PTV) showed a trend towards shorter weaning duration compared to synchronous intermittent mandatory ventilation (SIMV).
Conclusions:
- Both HFPPV and triggered ventilation offer benefits over conventional ventilation, reducing airleaks and ventilation duration, respectively.
- The precise mechanism for these benefits (i.e., true synchronization) could not be confirmed due to lack of advanced monitoring in trials.
- Further research is required to ascertain if synchronized ventilation reduces chronic oxygen dependency in neonates.