Non-invasive intermittent mandatory ventilation in preterm infants with respiratory distress syndrome immediately after extubation: a controlled study on synchronized non-invasive mechanical ventilation and review of the literature
Non-invasive ventilation is increasingly used in very low birth weight infants (VLBWI) to reduce complications from invasive ventilation. However, the physiological effects of synchronization during non-invasive nasal intermittent mandatory ventilation have not been tested in VLBWI immediately after extubation. Objectives: To study the short-term effects of synchronized nasal intermittent mandatory ventilation (S-NIMV) as compared to non-synchronized nasal IMV (NIMV) on breathing effort as measured by phasic esophageal pressure deflection (Pe), spontaneous respiratory rate (RR), gas exchange, cerebral tissue oxygen saturation (StO2), and intermittent episodes of bradycardia or hypoxemia in VLBWI recovering from respiratory distress syndrome (RDS). Methods: Fourteen VLBWI with RDS were studied using a randomized cross-over design during either S-NIMV or NIMV for 2 hours each immediately after extubation. A SophieR-Ventilator capable to synchronize mechanical breaths with a Graseby-Capsule was used for the study. Cerebral tissue oxygenation was measured using near infrared spectroscopy. The characteristics of the 14 infants were: five female, nine male; GA 26.3 ± 2.3 wks; birth weight (BW) 928 (475 - 1310) g; and postnatal age 6.5 (2 - 43) d. Results: Pe, spontaneous RR, and TcPCO2 decreased significantly while TcPO2 and synchrony rate increased significantly during S-NIMV as compared to NIMV. There was a trend towards a lower mean and diastolic blood pressure. There was no difference in average arterial oxygen saturation (SpO2), cerebral StO2, and severe bradycardia (defined as time with a heart rate < 100 beats per minute lasting more than10 seconds) and in hypoxemic episodes (SpO2 < 80 %) between the two modes. Conclusion: Synchronization during nasal ventilation immediately after extubation in VLBWI recovering from RDS improved gas exchange, decreased the respiratory effort and therefore seems to provide a more efficient respiratory support and synchrony.
Subject HeadingsAtemnot-Syndrom [GND]
Infants, premature [MeSH]
Respiratory distress syndrome, newborn [MeSH]
Work of breathing [MeSH]