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Volume targeting levels and work of breathing in infants with evolving or established bronchopulmonary dysplasia
Katie Hunt1,2, Theodore Dassios3, Kamal Ali3
1MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
Insights
A tidal volume target of 7 mL/kg significantly reduced the work of breathing in premature infants with bronchopulmonary dysplasia (BPD). This finding suggests 7 mL/kg may be more appropriate for ventilator-dependent infants.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Bronchopulmonary dysplasia (BPD) affects prematurely born infants, often requiring mechanical ventilation.
- Assessing the work of breathing is crucial for optimizing ventilator settings in these vulnerable infants.
Purpose of the Study:
- To evaluate the impact of different volume targeting levels on the work of breathing.
- To determine the optimal tidal volume target for infants with evolving or established BPD.
Main Methods:
- A randomized crossover study was conducted in a tertiary neonatal intensive care unit.
- Eighteen infants with BPD received ventilation at 4, 5, 6, and 7 mL/kg tidal volumes, with baseline measurements for comparison.
- The pressure-time product of the diaphragm (PTPdi) was measured as the primary outcome.
Main Results:
- The work of breathing (PTPdi) was highest at 4 mL/kg and progressively decreased with higher tidal volumes.
- Only the 7 mL/kg tidal volume target significantly reduced PTPdi compared to baseline.
- Significant reductions in PTPdi were observed at 7 mL/kg compared to 4, 5, and 6 mL/kg.
Conclusions:
- A tidal volume target of 7 mL/kg is effective in reducing the work of breathing in ventilator-dependent infants with BPD.
- This volume target may be more suitable for managing infants with evolving or established BPD.
- Optimizing tidal volume can improve respiratory support and potentially outcomes for premature infants with BPD.
Objectives:
To assess the work of breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD).
Design:
Randomised crossover study.
Setting:
Tertiary neonatal intensive care unit.
Patients:
Eighteen infants born at <32 weeks gestation who remained ventilated at or beyond 1 week after birth, that is, they had evolving or established BPD.
Interventions:
Infants received ventilation at volume targeting levels of 4, 5, 6 and 7 mL/kg each for 20 minutes, the levels were delivered in random order. Baseline ventilation (without volume targeting) was delivered for 20 minutes between each epoch of volume-targeting.
Main Outcome Measures:
Pressure-time product of the diaphragm (PTPdi), a measure of the work of breathing, at different levels of volume targeting.
Results:
The 18 infants had a median gestational age of 26 (range 24-30) weeks and were studied at a median of 18 (range 7-60) days. The mean PTPdi was higher at 4 mL/kg than at baseline, 5 mL/kg, 6 mL/kg and 7 mL/kg (all P≤0.001). The mean PTPdi was higher at 5 mL/kg than at 6 mL/kg (P=0.008) and 7 mL/kg (P<0.001) and higher at 6 mL/kg than 7 mL/kg (P=0.003). Only at 7 mL/kg was the PTPdi significantly lower than at baseline (P=0.001).
Conclusions:
Only a tidal volume target of 7 mL/kg reduced the work of breathing below the baseline and may be more appropriate for infants with evolving or established BPD who remained ventilator dependent at or beyond 7 days of age.
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