Optimal Conventional Mechanical Ventilation in Full-Term Newborns

Solberg, Marianne Trygg; Solevåg, Anne Lee; Clarke, Sara

doi:10.1097/anc.0000000000000525

Cited by 10 publications

(9 citation statements)

References 49 publications

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“…On the basis of our critically-ill study population, the period of intervention for each child was kept to a minimum. Applied and investigated ventilation techniques, however, are known to be clinically beneficial when patients are ventilated for longer periods [5,8,10]. For patients requiring long-term ventilation, EIS may therefore be a useful device for dynamic continuous bedside monitoring for pediatric intensive care patients.…”

Section: Discussionmentioning

confidence: 99%

“…Various ventilation modes have been established over the years, but have repeatedly shown undesirable side effects for children [1][2][3][4]. Synchronized intermittent mandatory ventilation (SIMV) has been shown to be a lung-protective strategy in pediatric intensive care [5]. Patient-ventilator-asynchrony during SIMV, has been described as pronounced [6] and even more in comparison to neurally adjusted ventilatory assist (NAVA) [7].…”

Section: Introductionmentioning

confidence: 99%

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Comparing ventilation modes by electrical impedance segmentography in ventilated children

Brandt

Mahlknecht

Werther

et al. 2022

J Clin Monit Comput

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Electrical impedance segmentography offers a new radiation-free possibility of continuous bedside ventilation monitoring. The aim of this study was to evaluate the efficacy and reproducibility of this bedside tool by comparing synchronized intermittent mandatory ventilation (SIMV) with neurally adjusted ventilatory assist (NAVA) in critically-ill children. In this prospective randomized case–control crossover trial in a pediatric intensive care unit of a tertiary center, including eight mechanically-ventilated children, four sequences of two different ventilation modes were consecutively applied. All children were randomized into two groups; starting on NAVA or SIMV. During ventilation, electric impedance segmentography measurements were recorded. The relative difference of vertical impedance between both ventilatory modes was measured (median 0.52, IQR 0–0.87). These differences in left apical lung segments were present during the first (median 0.58, IQR 0–0.89, p = 0.04) and second crossover (median 0.50, IQR 0–0.88, p = 0.05) as well as across total impedance (0.52 IQR 0–0.87; p = 0.002). During NAVA children showed a shift of impedance towards caudal lung segments, compared to SIMV. Electrical impedance segmentography enables dynamic monitoring of transthoracic impedance. The immediate benefit of personalized ventilatory strategies can be seen when using this simple-to-apply bedside tool for measuring lung impedance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Brandt

Mahlknecht

Werther

et al. 2022

J Clin Monit Comput

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“…So far, there are few studies conducted for adequate mechanical ventilation strategies for born at term (9,10). Since premature infants often require mechanical ventilation because of lung immaturity with a lack of endogenous surfactant causing RDS, many systemic reviews and Cochrane meta-analyses are based on the studies investigating different mechanical ventilation modes in extremely premature infants with respiratory distress syndrome (RDS) (11,12).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Assist/Control Ventilation with and without Volume Guarantee in Term or Near-Term Infants

et al. 2022

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Objectives: To compare the effects of volume guarantee combined with assist/control (AC) ventilation to AC alone on hypocarbia episodes and extubation success in infants born at or near term. Methods: In this prospective cohort study, infants >34 weeks in gestation at birth, who were born in our hospital supported by syncronised, time-cycled, pressure limited, assist /control ventilation (AC) or assist controlled volume guaranteed mechanical ventilation (AC + VG) were included. After admission, infants received either AC or VG+AC using by Leoni Plus (Heinen + Löwenstein GmbH, Bad Ems, Germany) ventilator. The ventilation mode was left to the clinician. In the AC group, peak airway pressure was set clinically. In the VG+AC group, desired tidal volume was set at 5 ml/kg, with the ventilator adjusting peak inspiratory pressure to deliver this volume. The study was completed once the patient extubated. Results: There were 35 patients in each group. Incidence of hypocarbia was lower in the VG+AC compared to AC (%17,1 and 22.8% respectively) but statistically not significant. Out of range PCO2 levels were lower in the VG+AC group and it reached borderline statistical significance ( p=0.06). The median extubation time was 70 (42-110) hours in the VG+AC group, 89.5 (48.5-115.5) hours in the AC group and it did not differ between groups (p=0.47). Conclusions: We found combining AC and VG ventilation compared to AC ventilation alone yielded similar hypocarbia episodes and extubation time for infants of >34 gestational weeks with borderline significance lower out of range PCO2 incidence.

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“…[ 12 ] With the progress of medical technology and the wide clinical application of PS, the cure rate of NRDS neonates has improved, but some neonates with severe illness still cannot achieve satisfactory curative effect, [ 13 ] especially CMV cannot achieve ideal ventilation and oxygenation effect under low oxygen concentration and pressure. [ 14 ] HFOV is a lung protection high-frequency ventilation strategy, and it is also the most frequent one among all high-frequency ventilation at present. It can improve oxygenation and reduce PaO 2 by enhancing gas exchange through convection and diffusion.…”

Section: Discussionmentioning

confidence: 99%

The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

et al. 2022

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Objective: To investigate the efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: This study is a retrospective clinical study. Seventy-two NRDS neonates were selected as the subjects from November 2019 to November 2020, and divided into observation group (40 cases, HFOV treatment) and control group (32 cases, conventional mechanical ventilation treatment). All cases were treated with PS and comprehensive treatment. The therapeutic effect, arterial partial pressure of oxygen (PaO 2 ), arterial partial pressure of carbon dioxide (PaCO 2 ), Percentage of inhaled oxygen concentration (FiO 2 ), mean arterialpressure, oxygenation index (OI), and complications were compared in the 2 groups. Results: The total effective rate of the observation group was 90.0%, significantly higher than that of the control group. After treatment, the observation group has higher PaO 2 levels and lower levels of PaCO 2 , mean arterial pressure, FiO 2 , and OI than the control group. There was no significant difference in the incidence of complications between the 2 groups. Conclusion: HFOV combined with PS has a significant effect on NRDS, which can improve the arterial blood gas index without increasing the incidence of complications.

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Optimal Conventional Mechanical Ventilation in Full-Term Newborns

Abstract: There is an urgent need for high-quality studies, preferably randomized controlled trials, in full-term newborns requiring mechanical ventilation to optimize oxygenation, ventilation, and short-term outcomes, potentially stratified according to the underlying pathology.

Cited by 10 publications

References 49 publications

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Comparing ventilation modes by electrical impedance segmentography in ventilated children

Comparison of Assist/Control Ventilation with and without Volume Guarantee in Term or Near-Term Infants

The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

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