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Synchronized mechanical ventilation for respiratory support in newborn infants
A Greenough1, G Dimitriou, M Prendergast
1King's College School of Medicine and Dentistry, Dept of Child Health, Bessemer Road, London, UK SE5 9PJ. anne.greenough@kcl.ac.uk
The Cochrane Database of Systematic Reviews
|February 7, 2008
Summary
Synchronized mechanical ventilation, including high frequency positive pressure ventilation (HFPPV) and triggered ventilation, reduces air leaks and shortens ventilation duration compared to conventional methods. Further research is needed to confirm benefits and optimize newer modes.
Area of Science:
- Neonatal respiratory support
- Mechanical ventilation strategies
- Pulmonary care in neonates
Background:
- Synchronized mechanical ventilation aligns positive airway pressure with spontaneous inspiration.
- This synchronization aims to improve gas exchange, reduce airway pressures, and minimize ventilator-induced lung injury.
- Methods to achieve synchronization include manipulating conventional ventilation settings and using patient-triggered ventilation.
Purpose of the Study:
- To compare the efficacy of synchronized ventilation (HFPPV, patient-triggered ACV/SIMV) against conventional mechanical ventilation (CMV).
- To evaluate different types of triggered ventilation (ACV, SIMV, PRVCV, SIMV+PS) against each other.
- To assess outcomes such as mortality, air leaks, intraventricular hemorrhage, and bronchopulmonary dysplasia.
Main Methods:
- Systematic review and meta-analysis of randomized or quasi-randomized clinical trials in neonates.
- Included trials compared synchronized ventilation modes (HFPPV, ACV/SIMV) to CMV.
- Analyzed data on mortality, air leaks (pneumothorax, PIE), IVH, BPD, and duration of ventilation/weaning.
Main Results:
- High-frequency positive pressure ventilation (HFPPV) significantly reduced the risk of air leak (pneumothorax).
- Assist control/synchronous intermittent mandatory ventilation (ACV/SIMV) shortened the duration of ventilation compared to CMV.
- No significant reduction in bronchopulmonary dysplasia (BPD) was observed for HFPPV or triggered ventilation; trends for mortality varied.
Conclusions:
- HFPPV and triggered ventilation demonstrate benefits in reducing air leaks and ventilation duration, respectively, compared to conventional ventilation.
- The precise mechanism of benefit (synchronization) could not be confirmed due to lack of complex monitoring in trials.
- Further adequately powered trials are needed to evaluate newer triggered ventilation modes and long-term outcomes.
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