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Randomized controlled trial of volume‐targeted synchronized ventilation and conventional intermittent mandatory ventilation following initial exogenous surfactant therapy
Author(s) -
Mrozek Jeanne D.,
BendelStenzel Ellen M.,
Meyers Pat A.,
Bing Dennis R.,
Connett John E.,
Mammel Mark C.
Publication year - 2000
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/(sici)1099-0496(200001)29:1<11::aid-ppul3>3.0.co;2-5
Subject(s) - medicine , ventilation (architecture) , oxygenation , tidal volume , intermittent mandatory ventilation , anesthesia , mean airway pressure , respiratory distress , mechanical ventilation , respiratory minute volume , surfactant therapy , gestational age , randomization , respiratory system , randomized controlled trial , pregnancy , mechanical engineering , biology , engineering , genetics
We set out to evaluate the impact of volume‐targeted synchronized ventilation and conventional intermittent mandatory ventilation (IMV) on the early physiologic response to surfactant replacement therapy in neonates with respiratory distress syndrome (RDS). We hypothesized that volume‐targeted, patient‐triggered synchronized ventilation would stabilize minute ventilation at a lower respiratory rate than that seen during volume‐targeted IMV, and that synchronization would improve oxygenation and decrease variation in measured tidal volume (V t ). This was a prospective, randomized study of 30 hospitalized neonates with RDS. Infants were randomly assigned to volume‐targeted ventilation using IMV (n = 10), synchronized IMV (SIMV; n = 10), or assist/control ventilation (A/C; n = 10) after meeting eligibility requirements and before initial surfactant treatment. Following measurements of arterial blood gases and cardiovascular and respiratory parameters, infants received surfactant. Infants were studied for 6 hr following surfactant treatment. Infants assigned to each mode of ventilation had similar birth weight, gestational age, and Apgar scores at birth, and similar oxygenation indices at randomization. Three patients were eliminated from final data analysis because of exclusionary conditions unknown at randomization. Oxygenation improved significantly following surfactant therapy in all groups by 1 hr after surfactant treatment ( P < 0.05). No further improvements occurred with time. Total respiratory rate was lowest ( P < 0.05) and variation in tidal volume (V t ) was least in the A/C group ( P < 0.05). Minute ventilation (V ′ E ), delivered airway pressures, respiratory system mechanics, and hemodynamic parameters were similar in all groups. We conclude that volume‐targeted A/C ventilation resulted in more consistent tidal volumes at lower total respiratory rates than IMV or SIMV. Oxygenation and lung mechanics were not altered by synchronization, possibly due to the volume‐targeting strategy. Of the modes studied, A/C, a fully‐synchronized mode, may be the most efficient method of mechanical ventilator support in neonates receiving surfactant for treatment of RDS. Pediatr Pulmonol. 2000; 29:11–18. © 2000 Wiley‐Liss, Inc.