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

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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 The common approach to this problem is a regular conventional mechanical ventilation, which is initiated and withdrawn in an "on/off" function. To develop and evaluate a mechanical backup ventilation mode that is adaptive to the rapidly changing breathing pattern of preterm infants. Prospective randomized clinical crossover trial. Neonatal intensive care unit at the University of Munich, Germany. Preterm infants undergoing PAV. 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. 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. 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.