Abstract
Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant. To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO2 in extremely preterm infants. This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO2) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO2, and electrical cardiometry (EC) were used in monitoring of the patients. Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients' mean postnatal age was 7.7 days. The SpO2 values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC. The circulatory parameters were comparable. The StO2 is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.
Highlights
Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in infants born prematurely with a very low birth weight (VLBW).[1]
There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC
One recent study conducted in Italy reported that VTV was chosen during the acute phase of RDS in only 27% of 113 tertiary neonatal intensive care unit (NICU), while in 45% of them this mode was only set during the weaning phase.[5]
Summary
Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in infants born prematurely with a very low birth weight (VLBW).[1]. Historically, PC ventilation that directly controls inspiratory pressure used to be the standard mode for preterm infants until technology advanced enough to allow accurate delivery of small expiratory tidal volumes (VTE) using VTV. According to the European Consensus Guidelines on the Management of RDS 2019, VTV is the preferred mode of ventilation because it enables clinicians to ventilate with less variable VTE and to lower the pressure in real time as lung compliance improves.[1]. One recent study conducted in Italy reported that VTV was chosen during the acute phase of RDS in only 27% of 113 tertiary NICUs, while in 45% of them this mode was only set during the weaning phase.[5]. The knowledge of the physiological effects of VTV is incomplete; the aim of this study was to assess the effects of VG ventilation on circulation and cerebral oxygenation (StO2) in extremely premature infants. Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant
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