Patient-triggered ventilation

Area of Science:

• Neonatal respiratory support
• Mechanical ventilation
• Infant lung function

Background:

• Optimal patient-ventilator synchrony is crucial for infants requiring mechanical ventilation.
• This synchrony depends on ventilator performance, triggering devices, and infant lung mechanics.
• Various triggered ventilation modes exist, including assist control (A/C), synchronous intermittent mandatory ventilation (SIMV), and pressure support ventilation (PSV).

Purpose of the Study:

• To evaluate the clinical outcomes and benefits of different patient triggered ventilation strategies in infants.
• To compare triggered ventilation with non-triggered positive pressure ventilation.
• To assess the impact of ventilation delivery methods (endotracheal tube vs. nasal prongs) and timing on outcomes.

Main Methods:

• Meta-analysis of randomized trials comparing A/C/SIMV with non-triggered ventilation.
• Review of small randomized trials on A/C vs. SIMV for weaning.
• Inclusion of physiological studies on pressure support ventilation (PSV) and proportional assist ventilation (PAV).

Main Results:

• A/C/SIMV demonstrated a shorter duration of ventilation compared to non-triggered ventilation, but no significant effect on chronic lung disease incidence.
• Reduced ventilation duration was observed only when triggered ventilation was initiated during the recovery phase of respiratory distress syndrome.
• Nasal prong delivery of triggered ventilation suggested a potential reduction in extubation failure rates.

Conclusions:

• Triggered ventilation, particularly when initiated in the recovery phase, can shorten ventilation duration but does not impact chronic lung disease.
• Assist control (A/C) may be a superior weaning mode compared to SIMV.
• Further randomized trials are needed to confirm the long-term clinical benefits of PSV and PAV.