Randomised weaning trial comparing assist control to pressure support ventilation

Shefali-Patel, Deena; Murthy, Vadivelam; Hannam, Simon; Lee, Silke; Rafferty, Gerrard F.; Greenough, Anne

doi:10.1136/archdischild-2011-300974

Cited by 11 publications

(2 citation statements)

References 15 publications

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“…A potential reason for benefits of PSV is that this mode of ventilation supports all breaths and was shown to reduce the work of breathing in preterm infants during the weaning phase ( 55 ). In a randomised weaning trial comparing ACV and PSV, however, the median duration of weaning did not differ significantly between the groups ( 56 ). No trials have addressed the impact of PSV on long-term outcomes.…”

Section: Invasive Ventilationmentioning

confidence: 99%

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Kaltsogianni¹,

Dassios²,

Greenough³

2023

Front. Pediatr.

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Mechanical ventilation (MV), although life-saving, is associated with chronic respiratory morbidity in both preterm and term born infants. New ventilation modes have been developed with the aim of minimising lung injury. These include invasive and non-invasive respiratory support strategies, techniques for less invasive surfactant administration (LISA) and closed-loop automated oxygen control (CLAC) systems. Increasingly, newborn infants with signs of respiratory distress are stabilised on continuous positive airway pressure (CPAP) and receive LISA. Early CPAP when compared to mechanical ventilation reduced the incidence of BPD and respiratory morbidity at 18 to 22 months corrected age. Nasal intermittent positive pressure ventilation reduced treatment failure rates compared to CPAP, but not bronchopulmonary dysplasia (BPD). LISA compared with intubation and surfactant delivery reduced BPD, but there is no evidence from randomised trials regarding long-term respiratory and neurodevelopmental outcomes. Synchronisation of positive pressure inflations with the infant's respiratory efforts used with volume targeting should be applied for infants requiring intubation as this strategy reduces BPD. A large RCT with long term follow up data demonstrated that prophylactic high frequency oscillatory ventilation (HFOV) improved respiratory and functional outcomes at school age, but those effects were not maintained after puberty. CLAC systems appear promising, but their effect on long term clinical outcomes has not yet been explored in randomised trials. Further studies are required to determine the role of newer ventilation modes such as neurally adjusted ventilator assist (NAVA). All such respiratory support strategies should be tested in randomised controlled trials powered to assess long-term outcomes.

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Section: Invasive Ventilationmentioning

confidence: 99%

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Kaltsogianni¹,

Dassios²,

Greenough³

2023

Front. Pediatr.

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“…Systematic reviews did not find a significant benefit for any of the ventilation modes over the others to improve long‐term clinical outcomes 4,5 . Studies examining short‐term benefits gave conflicting results 6‐10 . In any case, correct use of different ventilator modes requires the understanding of their logic and the differences among them.…”

Section: Introductionmentioning

confidence: 99%

Effect of pressure rise time on ventilator parameters and gas exchange during neonatal ventilation

Chong

Kayser

Szakmár

et al. 2020

Pediatric Pulmonology

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Background Pressure rise time (PRT), also known as slope time to the peak inflating pressure can be set on some modern neonatal ventilators. On other ventilators, PRT is determined by the set circuit flow. Changing slope time can affect mean airway pressure (MAP), oxygenation, and carbon dioxide elimination. Our aim was to investigate the effect of PRT on ventilator parameters and gas exchange during volume‐guaranteed ventilation. Methods In a crossover study, 12 infants weighing greater than 2 kg were ventilated using a Dräger Babylog VN500 ventilator with synchronized intermittent positive pressure ventilation with volume guarantee (SIPPV‐VG) and pressure support ventilation with volume guarantee (PSV‐VG). During both modes PRTs between 0.08 and 0.40 seconds were used in 15‐minute epochs. Data from the ventilator and patient monitors were downloaded with 1‐ and 100‐Hz sampling rate and analyzed using the Python computer language. Results During PSV‐VG, longer PRTs were associated with longer inspiratory time (P < .0001) and with lower peak inflating pressure (PIP; P = .003), but the MAP was similar. During SIPPV‐VG the PIP was not significantly different; however, MAP was lower with longer PRT (P = .001). With a short PRT (0.08 seconds), the PIP was higher during PSV‐VG than during SIPPV‐VG (19.8 vs 16.5 mbar; P = .042). There were no significant differences in tidal volume delivery, respiratory rate, minute volume, oxygen saturations, or end‐tidal CO2 with different PRTs in either mode. Conclusions During SIPPV‐VG or PSV‐VG, using short or long PRTs affects some ventilation parameters but does not significantly change oxygenation or carbon dioxide elimination.

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Synchronized mechanical ventilation for respiratory support in newborn infants

Greenough¹,

Murthy²,

Milner³

et al. 2016

Cochrane Database of Systematic Reviews

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Randomised weaning trial comparing assist control to pressure support ventilation

Abstract: No significant differences were found between weaning by PSV and ACV when similar inflation times were used.

Cited by 11 publications

References 15 publications

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Neonatal respiratory support strategies—short and long-term respiratory outcomes

Effect of pressure rise time on ventilator parameters and gas exchange during neonatal ventilation

Synchronized mechanical ventilation for respiratory support in newborn infants

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