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Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Inductance Plethysmography in Preterm Newborns Under Volume Guarantee Ventilation: A Crossover Study
Pedro Ykaro Fialho Silva1,2, Mayara Fabiana Pereira Costa1, Ingrid Guerra Azevedo3
1Department of Physical Therapy, Federal University of Rio Grande Do Norte/UFRN, Natal, Brazil.
Insights
Volume Guarantee (VG) ventilation improves chest expansion and oxygen saturation in preterm infants compared to Assist-Control (AC-PC) mode. This mode also shows a trend towards reduced heart rate, benefiting neonatal respiratory support.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Clinical Ventilation Strategies
Background:
- Preterm newborns have diaphragmatic dysfunction, leading to inefficient ventilation and increased energy expenditure.
- The diaphragm's flat, weak, and horizontal position in preterm infants compromises pulmonary mechanics.
Purpose of the Study:
- To compare chest expansion in preterm neonates under assist-control (AC-PC) and inspiratory pressure control with volume guarantee (VG) ventilation.
- To evaluate secondary ventilatory and autonomic outcomes associated with these ventilation modes.
Main Methods:
- A crossover clinical trial measured chest expansion via inductance plethysmography.
- Ventilatory (peak pressure, minute volume, compliance, resistance) and autonomic (heart rate, respiratory rate, SpO2) parameters were recorded.
- Measurements were taken at 0, 30, and 60 minutes with a 30-minute washout period between modes.
Main Results:
- Chest expansion was significantly higher in VG mode across all time points (T0, T30, T60).
- Peripheral oxygen saturation (SpO2) was higher in VG mode, particularly at T30.
- Heart rate was lower in VG mode at T60, with a non-significant trend for lower respiratory rate.
Conclusions:
- Volume Guarantee (VG) ventilation enhances chest expansion and peripheral oxygen saturation in preterm infants compared to AC-PC.
- VG ventilation may also contribute to a reduced heart rate in this population.
- These findings suggest VG as a potentially beneficial ventilation strategy for preterm neonates.
Introduction:
The diaphragm of preterm newborns is flat, weak and horizontally inserted in the rib cage. Consequently, it hampers the lever mechanism during muscle contraction, reduces the efficiency of pulmonary ventilation and chest expansion and increases energy expenditure.
Objective:
Primary outcome was to assess chest expansion using inductance plethysmography in preterm newborns during assist-control ventilation and inspiratory pressure control with and without volume guarantee (AC-PC and VG, respectively) and secondary outcomes were to assess ventilatory and autonomic outcomes.
Methods:
Chest expansion, as well as ventilatory (peak pressure, minute volume, dynamic compliance and airway resistance) and autonomic outcomes (heart rate, respiratory rate and peripheral oxygen saturation), were measured at 0, 30 and 60 min after initiation of ventilation in a crossover clinical trial study. A 30-min wash-out was performed between changes in ventilation modes.
Results:
We analysed 450 respiratory cycles of preterm newborns between 27 and 32 gestational age (weighted 964 ± 167.1 g). Chest expansion was higher in VG in T0 (p = 0.01), T30 (p < 0.01) and T60 (p = 0.04). Ventilatory outcomes are similar between two modes. Heart rate in VG mode was lower than AC-PC at T60 (p < 0.01), whereas peripheral oxygen saturation (SpO2) was higher at the three moments, being significant at T30 (p = 0.02). Although nonsignificant, respiratory rate was lower for VG when compared to AC-PC.
Conclusion:
VG may increase chest expansion and peripheral oxygen saturation compared with AC-PC mode, and reduce heart rate.
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