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Mechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during
M F el-Khatib1, R L Chatburn, D L Potts
1Division of Pediatric Pharmacology, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
Insights
The Bird VIP ventilator significantly reduced work of breathing and oxygen consumption (VO2) in pediatric patients compared to other models. Changes in VO2 may help track work of breathing, potentially aiding in ventilator weaning.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Mechanical ventilation
Background:
- Assessing patient work of breathing is crucial for optimizing mechanical ventilation in pediatric patients.
- Different ventilators may impact the effort required for a patient to trigger a breath during pressure-support ventilation.
- Oxygen consumption (VO2) is a physiological parameter that may correlate with the energy expenditure of breathing.
Purpose of the Study:
- To evaluate if different ventilators affect the work of breathing in pediatric patients on pressure-support ventilation.
- To determine if changes in oxygen consumption (VO2) correlate with changes in work of breathing.
Main Methods:
- Prospective study conducted in a university hospital's pediatric intensive care unit.
- Nine mechanically ventilated pediatric patients (2-75 months) were studied.
- Patients received pressure-support ventilation from three different ventilators (Siemens Servo 900C, Bird VIP, Newport Wave E200) in random order.
Main Results:
- The Bird VIP ventilator resulted in significantly lower work of breathing and oxygen consumption (VO2) compared to the Siemens Servo 900C and Newport Wave E200.
- The Newport Wave E200 also showed significantly lower work of breathing and VO2 than the Siemens Servo 900C.
- Trends in VO2 closely mirrored trends in work of breathing across all ventilators, with no significant changes in patient distress scores.
Conclusions:
- Modern mechanical ventilators, particularly the Bird VIP, can significantly reduce work of breathing and VO2 in pediatric patients.
- The Bird VIP's ability to lower work of breathing and VO2 suggests better patient-ventilator synchrony and potential for facilitating ventilator weaning.
- Monitoring changes in VO2 may serve as a useful surrogate for tracking changes in work of breathing.
Objectives:
a) To investigate whether the patient work of breathing needed to trigger inspiration is affected by the type of ventilator delivering pressure-support ventilation for mechanically ventilated pediatric patients. b) To determine whether changes in oxygen consumption (VO2) trend with changes in work of breathing and would thus be helpful in tracking work of breathing.
Design:
Prospective study.
Setting:
Pediatric intensive care unit at a university hospital.
Patients:
Nine mechanically ventilated patients (2 to 75 months of age).
Interventions:
While maintaining a constant pressure-support ventilation level, patients were alternately supported with the Siemens Servo 900C, the Bird VIP, and the Newport Wave E200 ventilators in random order.
Measurements And Main Results:
Work of breathing, defined as the integral of the pressure-volume curve corresponding to negative pressure, was calculated with a pulmonary monitoring system. VO2 was measured with a metabolic cart. Patient distress levels were assessed using the COMFORT scale, a behavioral scoring system. Mean values (20 breaths/patient) for measured variables with each ventilator were compared using analysis of variance and Scheffé tests, with p < .05 indicating statistical significance. The lowest VO2 (103 +/- 35 mL/min/m2) and work of breathing (24 +/- 15 g.cm/m2) were achieved with the Bird VIP ventilator and were significantly (p < .05) lower than those values obtained with either the Siemens Servo 900C (VO2 147 +/- 33 mL/min/m2; work of breathing 49 +/- 18 g.cm/m2) or the Newport Wave E200 (VO2 122 +/- 33 mL/min/m2; work of breathing 35 +/- 15 g.cm/m2). Also, the values of work of breathing and VO2 obtained using the Newport Wave E200 were significantly (p < .05) lower than those values obtained using the Servo 900C. No change in behavioral distress occurred when the ventilators were changed. In all patients, there was a clear similarity in the trends of VO2 and work of breathing.
Conclusions:
We conclude that VO2 and work of breathing may be reduced significantly using the latest generation of mechanical ventilators optimized for infant and pediatric use. Because work of breathing is less with the Bird VIP than the other two ventilators tested, leading to a corresponding decrease in VO2, we suggest that the Bird VIP better adapts the patient to the ventilator and may facilitate weaning from ventilatory support. We also suggest that changes in VO2 might be helpful in tracking changes in work of breathing.