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Manipulation of ventilator settings to prevent active expiration against positive pressure inflation
Insights
Active expiration against mechanical ventilation in infants may cause pneumothorax. However, this study found that altering ventilator settings prevented this interaction, and even when it persisted, pneumothorax did not develop.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Artificial ventilatory support is crucial for preterm infants.
- A specific breathing pattern, active expiration against ventilator inflations, has been implicated in pneumothorax development.
Purpose of the Study:
- To investigate the occurrence and impact of active expiration against mechanical ventilation in preterm infants.
- To determine if modifying ventilator settings can prevent this potentially harmful breathing pattern.
Main Methods:
- Observational study of 47 preterm infants undergoing mechanical ventilation.
- Analysis of breathing patterns, specifically focusing on the interaction between spontaneous breaths and ventilator inflations.
- Ventilator settings were adjusted to prevent active expiration against inflation.
Main Results:
- The pattern of active expiration against ventilator inflations was observed in 16 out of 51 study occasions.
- Altering ventilator settings successfully prevented this pattern in 14 of these instances.
- In two infants where the pattern persisted, pneumothorax did not occur.
Conclusions:
- The identified breathing pattern during mechanical ventilation in preterm infants is not consistently linked to pneumothorax.
- Adjusting ventilator settings is an effective strategy to mitigate this specific interaction.
- Further research may be needed to fully understand the multifactorial causes of pneumothorax in ventilated neonates.
Abstract:
Recent publications have suggested that in infants receiving artificial ventilatory support a particular pattern of interaction between spontaneous breaths and ventilator inflations (active expiration against each ventilator inflation) may be important in the production of pneumothoraces. We have looked at patterns of interaction from 47 preterm infants studied on 51 occasions. We found that active expiration against the ventilator occurred on a total of 16 occasions. This pattern was prevented on 14 occasions by altering the ventilator settings. In two other babies, the pattern persisted but neither baby developed a pneumothorax.