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Published on: July 14, 2023
Synchronized mechanical ventilation for respiratory support in newborn infants
Anne Greenough1, Vadivelam Murthy, Anthony D Milner
1Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London, Bessemer Road, London, UK.
Synchronised mechanical ventilation, including high-frequency positive pressure ventilation (HFPPV) and patient-triggered ventilation, reduces air leaks and ventilation duration compared to conventional methods. Further research is needed to confirm benefits and optimize new modes.
Area of Science:
- Neonatal respiratory support
- Mechanical ventilation strategies
- Clinical trial methodology
Background:
- Synchronised mechanical ventilation aligns positive airway pressure with spontaneous inspiration.
- This synchrony may reduce ventilator-induced lung injury (VILI) and improve outcomes like air leak and bronchopulmonary dysplasia (BPD).
- Methods to achieve synchrony include manipulating conventional ventilator settings or using patient-triggered ventilation.
Purpose of the Study:
- To compare the efficacy of synchronised ventilation (HFPPV, ACV, SIMV) against conventional ventilation or HFO.
- To evaluate different patient-triggered ventilation modes (ACV, SIMV, PRVCV, SIMV+PS, PSV).
Main Methods:
- Systematic review and meta-analysis of randomised and quasi-randomised controlled trials.
- Searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trial databases.
- Included trials comparing synchronised ventilation modes in neonates.
Main Results:
- HFPPV vs. CMV reduced air leak risk (pneumothorax).
- ACV/SIMV vs. CMV shortened ventilation duration.
- SIMV or SIMV+PS vs. HFO showed increased risk of moderate/severe BPD and longer ventilation duration.
- No significant reduction in BPD incidence with HFPPV or triggered ventilation; trends for mortality were non-significant.
Conclusions:
- HFPPV and triggered ventilation demonstrate benefits in reducing air leak and ventilation duration, respectively, compared to conventional ventilation.
- The mechanism of benefit (synchrony) could not be confirmed due to lack of complex monitoring.
- Further adequately powered trials are essential to assess long-term outcomes of newer triggered ventilation modes before routine clinical adoption.
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