Introduction: Little is known about the amount of work of breathing (WOB) associated with infants breathing on neonatal ventilators. We proposed that differences in the response time of different trigger systems would lead to differences in resistive WOB (WOBR) in ventilated preterm neonates. Methods: Twenty five intubated, sedated, spontaneously breathing neonatal piglets weighing 1,000 grams were studied. Resistive WOB[WOBR (gm cm/kg)] was measured utilizing an esophageal balloon and a flow transducer attached to a Bicore Neonatal CP-100 monitor. Each breath was further analyzed for response time in milliseconds (ms) with a computerized data acquisition program. Each animal was studied with two neonatal ventilators on at least three separate days [Siemens SV300 and Drager Babylog(DBL) in CPAP of 0,3,5 cm H20 and with the SV300 in pressure support 5 cm H20. All data were analyzed utilizing a Wilcoxon Signed Rank Test.Results: Comparing the SV300 and DBL, WOBR for CPAP=0 was 63±27 vs. 78±32 (p=0.004), for CPAP=3 was 72±29 vs. 94±31(p=0.001), and for CPAP=5 was 76±38 vs. 105±40(p=0.001) respectively. Overall WOBR for the SV300 was 71±31and for the DBL was 92±34 at all levels of CPAP, representing a decreased WOBR of 31% with the SV300. Pressure support of +5 cm H20 with the SV300 further decreased the WOBR by 27% compared to CPAP=5(p= 0.01) on the DBL.The trigger phase with the SV300 was 351ms and 442ms with the DBL (p=0.03), this 26% difference in the ventilator response time from the first negative deflection to intiation of gas flow may explain the increased WOBR with the DBL. Another distinct difference between these two ventilators was in the beginning of the trigger phase. It was observed of the mean time span of pressure deflection of each breath was 331ms or 260% greater in the DBL vs. the SV300. Conclusion: In intubated patients, maximum energy expenditure occurs at initiation of ventilators breaths. WOBR in premature piglets was significantly increased by the slower response times of the DBL vs the SV300 ventilator. These differences have important implications for energy kinetics and weight gain in ventilated preterm neonates.
Read full abstract