Synchronous Respiration: Which Ventilator Rate Is Best?

Greenough, Anne; Greenall, F; Gamsu, H R

doi:10.1111/j.1651-2227.1987.tb10554.x

Cited by 47 publications

(19 citation statements)

References 18 publications

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“…It is tempting to speculate that this reduction in the occurrence of air leak is due to the introduction of fast rate ventilation, to promote synchrony [8][9][10] used in association with selective paralysis of only those infants who fail to synchronize despite increase of the ventilator rate.…”

Section: Discussionmentioning

confidence: 97%

Neonatal complications of extreme prematurity in mechanically ventilated infants

1992

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Previous data have suggested that neonatal complications amongst preterm ventilated infants increase with decreasing gestational age and thus are likely to be greatest among ventilated infants of less than 28 weeks gestational age. The aim of this study was to test that hypothesis, thus we report the neonatal complications of 175 extremely preterm mechanically ventilated infants (gestational age less than or equal to 28 weeks). Of the infants 152 were ventilated because of respiratory distress syndrome (RDS) or respiratory distress of severe prematurity, 41% of these infants died. Amongst infants with RDS or respiratory distress of extreme prematurity, mortality was significantly increased in infants of gestational age less than or equal to 24 weeks and birth weight less than or equal to 1000 g. In this group 20% developed a pneumothorax, and mortality was inversely related to gestational age. In infants with RDS, 43% developed a periventricular haemorrhage and 37% were still oxygen-dependent at 28 days of age; neither of these complications was significantly related to birth weight or gestational age. Of infants with RDS 38% developed a patent ductus arteriosus and 16% developed retinopathy of prematurity. These data suggest that even amongst very immature infants there has been an impressive reduction in the neonatal complications of mechanical ventilation.

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Section: Discussionmentioning

confidence: 97%

Neonatal complications of extreme prematurity in mechanically ventilated infants

1992

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“…In infants suffering from acute respiratory disease, patient triggered ventilation (PTV) can improve oxygenation when compared to conventional ventilation [3,6], enabling peak inspiratory Offprint requests to: A. Greenough…”

Section: Introductionmentioning

confidence: 99%

Patient triggered ventilation in chronically ventilator-dependent infants

Hird

Greenough

1991

Eur J Pediatr

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Patient triggered ventilation (PTV) has been assessed as a method of respiratory support in infants remaining ventilator-dependent beyond the 1st week of life. Sixteen preterm infants were studied who had a median gestational age of 26 weeks and postnatal age of 22 days. PTV was delivered using a ventilator incorporating an airway pressure trigger. PTV was only successfully maintained until extubation in 3 infants, failing to provide a satisfactory method of respiratory support in the remaining 13 infants after a median of 1 h (range 1-10). One of the 13 infants was persistently asynchronous at 1 h despite manipulation of inflation time. The other 12 infants, at failure of PTV, were making respiratory efforts which were inadequate to consistently trigger the ventilator. Infants in whom PTV was successful were older, more mature and of greater birth weight; the trigger delay at 1 h was significantly shorter in this group (P less than 0.05). A predictor of failure of PTV was asynchrony in the 1st h after commencing PTV (P less than 0.02). We conclude PTV incorporating an airway pressure trigger infrequently provides a useful method of respiratory support in infants who are chronically ventilator-dependent.

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“…There have now been two recent reports assessing ventilator performance at high rates, using lung models [5,23]. Boros et al, using a lung simulator with a compliance of 1.0 ml/cm H20 and resistance of 200 cm H20/1 per s, found that tidal exchange was maintained as rates were increased up to 75 breaths per rain but then fell by variable amounts.…”

Section: Ventilator Performancementioning

confidence: 97%

“…Two studies have shown this to be successful in many infants [12,21], Field et al, also stressing the importance of the reduced inspiratory time. Greenough [23] demonstrated that the increased ventilator rate at which synchrony occurred was dependent on gestational age, babies of less than 32 weeks breathing synchronously at rates of 120/min while more mature babies were usually synchronous at rates of about 60-70/ rain. She also investigated the babies' spontaneous respiratory rates by disconnecting the babies from the ventilator for short periods [23].…”

Section: Baby and Ventilator Interactionsmentioning

confidence: 98%

“…Greenough [23] demonstrated that the increased ventilator rate at which synchrony occurred was dependent on gestational age, babies of less than 32 weeks breathing synchronously at rates of 120/min while more mature babies were usually synchronous at rates of about 60-70/ rain. She also investigated the babies' spontaneous respiratory rates by disconnecting the babies from the ventilator for short periods [23]. An inverse relationship between gestational age and respiratory rate was demonstrated and she concluded that synchrony could usually be achieved by adopting ventilator rates that were higher than the babies' own spontaneous breathing rates.…”

Section: Baby and Ventilator Interactionsmentioning

confidence: 98%

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High frequency ventilation in the neonatal period

Greenough

Milner

1987

Eur J Pediatr

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There are three forms of high frequency ventilation, high frequency jet ventilation (HFJV, up to 400/min), high frequency oscillation (HFO, up to 40 Hz), and high frequency positive pressure ventilation (HFPPV, rates between 60 and 150/min). The first two forms of ventilation are still experimental and have been used only in critically ill children where respiratory failure has been unresponsive to more conventional therapy. Unfortunately, however, HFJV has already been associated with a high incidence of tracheal lesions. High-frequency positive pressure ventilation, on the other hand, using conventional ventilators, has been used and studied widely. Certain neonatal ventilators function suboptimally at increased rates, resulting in a reduction in tidal exchange with a consequent clinical deterioration. Using appropriate ventilators, arterial oxygen tensions improve and carbon dioxide tensions are reduced at fast rates in non-paralysed infants. Air-trapping, however, may be a problem in infants paralysed and ventilated at fast rates. HFPPV have been associated with a reduced incidence of pneumothoraces, but there is no knowledge of the effect of this form of ventilation on subsequent lung growth.

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Synchronous Respiration: Which Ventilator Rate Is Best?

Cited by 47 publications

References 18 publications

Neonatal complications of extreme prematurity in mechanically ventilated infants

Neonatal complications of extreme prematurity in mechanically ventilated infants

Patient triggered ventilation in chronically ventilator-dependent infants

High frequency ventilation in the neonatal period

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