Inversed ratio ventilation as an rescue option for ventilation of very premature infants

Abstract

Objective: We report on three very premature infants who were treated with inverse ratio ventilation (IRV) using a high ventilation frequency (˜60/min) as a rescue method for oxygenation. IRV has become a popular mode of ventilation in adults, but has not been used in premature infants so far. The idea of using IRV stems from a concern of possible ventilator-induced lung injury using high peak pressures to generate higher mean inspiration pressures. Using IRV creates the possibility to increase tidal volumes, overcome the critical opening pressure during inspiration and better alveolar recruitment without increasing the peak pressure. Patients: Three extremely premature infants with a birth weight ranging from 640g and 990g. All of them could not be ventilated adequately with conventional ventilation neither with high frequency oscillation. They were treated with high frequency inverse ratio ventilation. Measurements and main result: At our NICU oxygen saturation, paO2, paCO2 were measured on a regular basis and ventilation modified accordingly. When our standard ventilation schemes failed, high frequency inverse ration ventilation was used a rescue method. When this failed IRV was used as a rescue method. All infants had significant benefit of our IVR ventilation scheme. Conclusion: It seems that in our setting we were able to combine the benefits of pcIRV and of high frequency positive pressure ventilation. The IRV scheme was well tolerated without additional sedation or relaxation needed. All three infants left our NICU without radiological signs of severe BPD. Further studies are needed to describe the possible beneficial role of high frequency pcIRV in premature infants with respiratory failure