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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 2, 2001
Summary
Synchronized mechanical ventilation, including high frequency positive pressure ventilation (HFPPV) and triggered ventilation (PTV/SIMV), reduces airleaks and ventilation duration in neonates compared to conventional methods. Further research is needed to confirm other benefits.
Area of Science:
- Neonatal respiratory support
- Mechanical ventilation strategies
- Pulmonary mechanics in neonates
Background:
- Synchronized mechanical ventilation aligns positive airway pressure with spontaneous inspiration.
- This synchronization aims to improve gas exchange, reduce peak airway pressures, and minimize barotrauma, airleaks, and chronic lung disease.
- Methods to achieve synchronization include manipulating conventional ventilation settings and employing patient-assisted ventilation.
Purpose of the Study:
- To compare the efficacy of synchronized mechanical ventilation (high frequency positive pressure ventilation [HFPPV] or triggered ventilation [PTV/SIMV]) against conventional mechanical ventilation (CMV) in neonates.
- To compare different types of triggered ventilation (PTV vs. SIMV).
Main Methods:
- Systematic review and meta-analysis of randomized or quasi-randomized clinical trials from 1985-2000.
- Searched databases including Oxford Database of Perinatal Trials and Medline.
- Included trials comparing HFPPV or PTV/SIMV to CMV, and PTV to SIMV in neonates, analyzing outcomes like mortality, airleaks, intraventricular hemorrhage, chronic lung disease, and ventilation duration.
Main Results:
- High frequency positive pressure ventilation (HFPPV) significantly reduced the risk of airleaks (pneumothorax) compared to conventional mechanical ventilation (CMV).
- Patient triggered ventilation/synchronous intermittent mandatory ventilation (PTV/SIMV) was associated with a shorter duration of ventilation compared to CMV.
- PTV showed a trend towards shorter weaning duration compared to SIMV; no significant reduction in chronic lung disease was observed for either HFPPV or triggered ventilation.
Conclusions:
- Both HFPPV and triggered ventilation demonstrate benefits over conventional ventilation, specifically in reducing airleaks and ventilation duration, respectively.
- The exact mechanism (e.g., synchronization) producing these benefits could not be confirmed due to a lack of complex respiratory monitoring in the included trials.
- Further trials are recommended to explore other potential benefits of synchronized ventilation, emphasizing the need for optimized trigger and ventilator design.