Neonatal Ventilation: Evidence Based or Technological Conundrum

Abstract

Background: Meta analyses on neonatal mechanical ventilation suggested no difference between conventional and patient triggered ventilation (PTV) in preterm neonates. Newer forms of respiratory support with perceived advantages continue to entice Neonatologists. Objective: To ascertain the current trends in respiratory management of the very preterm infant (< 28 weeks) in level 3 neonatal units. Methods: A structured questionnaire was designed and a senior staff interviewed in all level 3 neonatal units in England telephonically by one interviewer in September 2010. Results: Of the 54 units identified from BAPM database 98% responded. Pressure controlled ventilation was the primary mode of mechanical ventilation in 69.8% units, volume targeted ventilation in 24.5% and HFOV used in 5.7% units. SIMV or SIMV with Pressure Support (PSV) was the most preferred method in 83.1% units for weaning off mechanical ventilation. PSV was used in 50.9% units with 7.5% units using more than 50% PSV. Tidal volume was targeted in 69.8% units with 54.7% aiming a tidal volume of 4-7mls/kg. High flow nasal cannula oxygen was used in 47.2% units along with CPAP or BiPAP. 28.3% units administered Caffeine in the acute phase of RDS; the rest administered it when the infant was ready for extubation. Only 7.6% used an objective criterion to assess readiness for extubation. Conclusions: Contrary to the current evidence, neonatal ventilation practices have evolved using patient triggered modes of ventilation. Further trials are warranted to improve generalisability of evidence into clinical practice.

The Effect of Blood Glucose and pCO₂ on Spectral EEG of Premature Infants during the First Three Days of Life

“…Thus, it could have been expected that the adaptation of the brain to these biochemical changes had improved with time. Brain background activity is dependent on GA [14,15]; therefore, it is interesting that the effect of pCO 2 and glucose was similar in the two groups. Whether the effect on tABP caused by increased pCO 2 and blood glucose is a sign of a deleterious effect on the brain remains unclear.…”

Understanding Neonatal Ventilation: Strategies for Decision Making in the NICU

“…If a unit is only able to deliver special care, transfer may be necessary to a higher level unit and the type of ventilation may then be determined by unit practices and trends of use of various modes. A UK wide survey of ventilation strategies within 54 tertiary level neonatal units was undertaken (46) and found that the use and availability of modes to be variable. 98% response to a structured questionnaire found that pressure controlled ventilation was most frequently used as the primary form of ventilator support (69.8%) compared to volume targeted (24.5%) and HFOV (5.7%).…”