Synchronized mechanical ventilation for respiratory support in newborn infants

Area of Science:

• Neonatal respiratory support
• Mechanical ventilation strategies
• Critical care medicine

Background:

• Synchronised mechanical ventilation aligns positive airway pressure with spontaneous inspiration.
• This approach aims to improve gas exchange, reduce ventilator-induced lung injury (VILI), and decrease complications 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 (CMV) or high-frequency oscillation (HFO).
• To evaluate different patient-triggered ventilation modes (ACV, SIMV, PRVCV, SIMV with PS, PSV).

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched Cochrane Neonatal Review group, MEDLINE, EMBASE, CINAHL, and clinical trials databases.
• Included studies comparing synchronised ventilation modes (HFPPV, ACV, SIMV) to CMV or HFO, and trials comparing different triggered ventilation modes in neonates.

Main Results:

• HFPPV vs. CMV reduced air leak risk (pneumothorax RR 0.69).
• ACV/SIMV vs. CMV shortened ventilation duration (MD -38.3 hours).
• SIMV or SIMV + PS vs. HFO increased risk of moderate/severe BPD (RR 1.33) and prolonged ventilation duration.

Conclusions:

• HFPPV and triggered ventilation demonstrate benefits in reducing air leak and ventilation duration, respectively, compared to conventional ventilation.
• Current trials lack complex respiratory monitoring, limiting conclusions about the mechanism of benefit.
• Further adequately powered randomized trials are essential to evaluate newer triggered ventilation modes and optimize ventilator design for clinical practice.