Randomised controlled trial of weaning by patient triggered ventilation or conventional ventilation

A group of preterm infants (n = 40) were entered into a randomised controlled trial to compare the duration and efficacy of weaning by patient triggered ventilation (PTV) or conventional ventilation. Once recovery from respiratory distress had begun, enabling the ventilator rate to be reduced to 40 breaths/min, infants were randomised to either regime. Infants randomised to PTV were weaned by reduction in ventilator pressure only, whereas infants randomised to conventional ventilation were weaned by reduction in ventilator rate only. Only one infant required re-ventilation within 24 h of extubation; this infant had been weaned by conventional ventilation. Three infants, all of less than 28 weeks gestation, did not tolerate weaning by PTV and were subsequently weaned conventionally. The duration of weaning was analysed according to the original randomisation allocation and was significantly shorter in the PTV group, being a median of 30 h (mean 39, range 3-186) compared to a median of 61 h (mean 65, range 15-262) in the conventional group, P < 0.02. We conclude PTV is the more advantageous form of weaning in preterm infants of greater than 27 weeks gestational age.