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Synchronized ventilation of very-low-birth-weight infants; report of 6 years' experience
1Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, Inciraltu-Izmir, Turkey.
Insights
Patient-triggered ventilation (PTV) is feasible for very-low-birth-weight infants with respiratory distress. Optimization of ventilator settings is crucial for successful outcomes in these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Very-low-birth-weight infants often experience respiratory distress.
- Mechanical ventilation is a critical intervention for neonatal respiratory insufficiency.
- Patient-triggered ventilation (PTV) offers a more physiological approach compared to conventional methods.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of long-term patient-triggered ventilation (PTV) in very-low-birth-weight infants.
- To compare the use of Assist/Control and Synchronized Intermittent Mandatory Ventilation (SIMV) modes within PTV.
- To identify key outcome measures including survival, morbidity, and duration of ventilatory support.
Main Methods:
- A retrospective analysis of 97 very-low-birth-weight infants requiring synchronized ventilation for respiratory distress or insufficiency.
- Data collected from January 1995 to December 2000.
- Outcome measures included mortality, oxygen support, pneumothorax, intracranial hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity, and duration of ventilation.
Main Results:
- 84% of infants survived, with a survival rate of 83.5% without major morbidity.
- The mean duration of ventilator support was 4.7 days for survivors.
- Major morbidities such as severe intracranial hemorrhage (15%) and periventricular leukomalacia (12%) were observed, while necrotizing enterocolitis and retinopathy of prematurity were rare.
Conclusions:
- Patient-triggered ventilation (PTV), utilizing Assist/Control and SIMV modes, is a feasible ventilatory strategy for very-low-birth-weight infants with respiratory distress.
- Effective implementation requires careful optimization of ventilator trigger sensitivity and performance tailored to specific respiratory diagnoses.
- This approach supports physiological breathing patterns and can lead to favorable outcomes in this vulnerable population.
Objectives:
To evaluate the effects of long-term patient triggered ventilation (PTV) using assist/control or synchronized intermittent mandatory ventilation (SIMV) in very-low-birth-weight infants with respiratory distress.
Methods:
Ninety-seven very-low-birth-weight infants who had undergone synchronized ventilation for respiratory distress or insufficiency were assessed from January 1995 to December 2000. Death, oxygen support, pneumothorax development while ventilated, intracranial hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity and duration of ventilation were noted as the mean outcome measures.
Results:
The mean birth weight was 1139 +/- 268 g (range 450-1500 g) and the mean gestational age was 29.0 +/- 2.8 weeks (range 23-36 weeks). Eighty-four per cent of 97 infants survived. Antenatal steroids were administered to only 20% of mothers. Surfactant was administered to all of the 67% of infants with respiratory distress syndrome. The mean duration of ventilator support was 4.7 +/- 7.3 days (1-43 days) for survivors and 8.9 +/- 11 days (1-45 days) for infants who died. No respiratory paralysis was necessary in any case during ventilation and pneumothorax was diagnosed in only eight infants. Severe intracranial hemorrhage (grade > or = III) and periventricular leukomalacia developed in 15% and 12% of infants, respectively. Necrotizing enterocolitis (Bell's classification stage > or = 2) and retinopathy of prematurity were noted in two infants. Four infants had evidence of chronic lung disease. The rate of survival without major morbidity was 83.5%.
Conclusion:
Patient-triggered ventilation, initially PTV with Asist/Control and subsequently with SIMV in very-low-birth-weight infants with respiratory distress is feasible, but optimization of trigger and ventilator performance with respect to respiratory diagnosis is essential.
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