Randomized, Controlled Trial Comparing Synchronized Intermittent Mandatory Ventilation and Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants

Abstract

The results of this study suggest that the addition of pressure support as a supplement to synchronized intermittent mandatory ventilation during the first 28 days may play a role in reducing the duration of mechanical ventilation in extremely low birth-weight infants, and it may lead to a reduced oxygen dependency in the 700- to 1000-g birth weight strata.

Neonatal ventilators: how do they differ?

“…26 Pressure support ventilation Trials examining the use of PSV in newborns have also been limited to physiological effects and short-term outcome measures, but the results are encouraging and suggest the need for future trials. 6 The studies of Reyes et al 27 and Gupta et al 28 show the benefits of PSV in improving spontaneous tidal volumes and minute ventilation. Further work needs to be carried out to address the optimal balance between mechanical and spontaneous support.…”

Mechanical Ventilation of the Premature Neonate

“…Gupta et al 28 observed greater increase in minute ventilation and a concomitant reduction in patient respiratory rate in neonates supported with PC-SIMV with pressure support, versus PC-SIMV without pressure support. Reyes et al 29 conducted an RCT with 107 premature neonates with RDS, allocated to PC-SIMV either with or without pressure support, for 28 d. The neonates who received pressure support reached minimal ventilator settings and were extubated sooner than the PC-SIMV-only group. The pressure-support subgroup of infants who weight 700 -1,000 g had a shorter exposure to supplemental oxygen, but also received more surfactant.…”

Setting the Ventilator in the NICU

“…This will compensate for the problems associated with simple SIMV but becomes a more complex process requiring the clinician to select settings for both SIMV and the level of pressure support. Nonetheless, more rapid weaning when SIMV was combined with PSV compared to SIMV alone has been demonstrated (Reyes et al 2006 ). Based on these fi ndings, it is recommended that when SIMV is used during the weaning process, PSV should be utilised to support spontaneous breathing.…”