Adaptive mechanical backup ventilation for preterm infants on respiratory assist modes - a pilot study

Intensive Care Med. 2006 Feb;32(2):302-308. doi: 10.1007/s00134-005-0003-7. Epub 2006 Jan 24.

Abstract

Background: Mechanical respiratory-assist modes, such as assist/control, low-rate intermittent mandatory ventilation, continuous positive airway pressure, or proportional assist ventilation (PAV), require a continuous respiratory effort. Because of the frequent occurrence of periodic breathing and/or apnea, mechanical backup ventilation must be initiated during episodes of reduced or absent respiratory drive to maintain gas exchange. The common approach to this problem is a regular conventional mechanical ventilation, which is initiated and withdrawn in an "on/off" function.

Objective: To develop and evaluate a mechanical backup ventilation mode that is adaptive to the rapidly changing breathing pattern of preterm infants.

Design: Prospective randomized clinical crossover trial.

Setting: Neonatal intensive care unit at the University of Munich, Germany.

Patients: Preterm infants undergoing PAV.

Interventions: The infants were ventilated with PAV using a newly developed adaptive backup support, with and without pulse-oximetry-guided operation (SpO(2)-sensitive backup). Each infant was ventilated with both modes of backup support on 2 consecutive days, with the sequence randomized.

Measurements and results: The analysis on 11 preterm infants showed a statistically significant and clinically relevant reduction of the incidence (33%) and duration of oxygen desaturations (52%) when SpO(2)-sensitive adaptive backup support was used.

Conclusions: SpO(2)-sensitive adaptive backup proved safe and effective in reducing the incidence and duration of oxygen desaturation in this short-term trial. This technology is potentially applicable to other assisted modalities of ventilation, such as noninvasive nasal ventilation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal
  • Male
  • Pilot Projects
  • Prospective Studies
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome, Newborn / physiopathology
  • Respiratory Distress Syndrome, Newborn / therapy*
  • Statistics, Nonparametric
  • Treatment Outcome