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Ventilation practices in the neonatal intensive care unit: a cross-sectional study
Anton H van Kaam1, Peter C Rimensberger, Dorine Borensztajn
1Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
The Journal of Pediatrics
|July 13, 2010
Summary
Time cycled pressure-limited ventilation is common in neonatal intensive care units. Tidal volumes are typically 4-7 mL/kg, and positive end-expiratory pressure is 4-6 cmH2O, with newer modes used less frequently.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Mechanical ventilation is crucial for critically ill newborns.
- Optimizing ventilation strategies aims to minimize lung injury and improve outcomes.
- Current practices in neonatal ventilation require regular assessment.
Purpose of the Study:
- To evaluate contemporary mechanical ventilation techniques employed in European neonatal intensive care units.
- To identify the most prevalent ventilation modes and settings used for endotracheally intubated infants.
Main Methods:
- A multi-center, 2-point cross-sectional study was performed across 173 European NICUs.
- Data were collected from 535 infants with a mean gestational age of 28 weeks.
- Ventilator settings and patient parameters were recorded bedside.
Main Results:
- Conventional ventilation was used in 85% of infants, with time cycled pressure-limited ventilation being the most common mode (59%).
- Synchronized intermittent mandatory ventilation was frequently combined with pressure-limited ventilation (51%).
- Mean tidal volume was 5.7 ± 2.3 mL/kg, and mean positive end-expiratory pressure was 4.5 ± 1.1 cmH2O.
Conclusions:
- Time cycled pressure-limited ventilation remains the predominant method for neonatal mechanical ventilation.
- Current tidal volume targets generally fall within the 4-7 mL/kg range, with PEEP typically between 4-6 cmH2O.
- Advanced ventilation modes are underutilized in this population.
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