Patient-triggered ventilation in premature neonates.

Abstract

Observed short-term benefits of patient-triggered ventilation include improvements in oxygenation and carbon dioxide elimination, reduced cerebral blood flow variability, more rapid weaning from ventilation and reduced adrenaline levels. The three multicentre randomized controlled trials in which longer term outcomes were investigated failed to demonstrate any consistent reductions in rates of pneumothorax, chronic lung disease, cranial ultrasound changes, duration of ventilation or mortality. Two of these studies were conducted wholly or predominantly using the SLE 2000 ventilator, with the Drager Babylog 8000 used in a minority of infants. The results therefore reflect only the performance of these ventilators, with the ventilation techniques used. As the degree to which synchrony was achieved was not measured in any of these studies, they provide no evidence for a lack of benefit from achieving synchronous ventilation. It is possible that the findings were influenced by the use of drugs, especially morphine and theophylline. In one study the pneumothorax rate was significantly lower in infants recruited within 3 mo of the first patient enrolled at that centre, and was seen with both modes of ventilation. This suggests that staff education in ventilation techniques may be important in reducing pneumothorax rates.