Neonatal ventilatory techniques - which are best for infants born at term?

Olie Chowdhury, Anne Greenough, Olie Chowdhury, Anne Greenough

Abstract

Few studies have examined ventilatory modes exclusively in infants born at term. Synchronous intermittent mandatory ventilation (SIMV) compared to intermittent mandatory ventilation (IMV) is associated with a shorter duration of ventilation. The limited data on pressure support, volume targeted ventilation and neurally adjusted ventilatory assist demonstrate only short term benefits in term born infants. Favourable results of high-frequency oscillatory ventilation (HFOV) in infants with severe respiratory failure were not confirmed in the two randomised trials. Nitric oxide (NO) in term born infants, except in those with congenital diaphragmatic hernia (CDH), reduces the combined outcome of death and requirement for extracorporeal membrane oxygenation (ECMO). In infants with severe refractory hypoxaemic respiratory failure, ECMO, except in infants with CDH, reduced mortality and the combined outcome of death and severe disability at long-term follow-up. Randomised studies with long term outcomes are required to determine the optimum modes of ventilation in term born infants.

Keywords: extracorporeal membrane oxygenation; high frequency oscillation; nitric oxide; patient triggered ventilation.

References

    1. Gouyon JB, Ribakovsky C, Ferdynus C, et al. Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol. 2008;22:22–30.
    1. Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol. 2005;25:251–7.
    1. Lian W, Yeo CL, Ho LY. Two-year outcome of normal-birth-weight infants admitted to a Singapore neonatal intensive care unit. Ann Acad Med Singapore. 2002;31:199–205.
    1. Angus DC, Linde-Zwirble WT, Clermont G, Griffin MF, Clark RH. Epidemiology of neonatal respiratory failure in the United States: projections from California and New York. Am J Respir Crit Care Med. 2001;164:1154–60.
    1. Sutton L. Population-based data on full-term neonates with severe morbidity. Sem Neonatol. 1997;2:189–93.
    1. Greenough A, Patel DS. Neonatal ventilation techniques - which is best for prematurely born infants? Arch Med Sci. 2008;2:116–21.
    1. Greenough A, Morley C, Davis J. Interaction of spontaneous respiration with artificial ventilation in preterm babies. J Pediatr. 1983;103:769–73.
    1. Heicher DA, Kasting DS, Harrod JR. Prospective clinical comparison of two methods for mechanical ventilation of neonates: rapid rate and short inspiratory time versus slow rate and long inspiratory time. J Pediatr. 1981;98:957–61.
    1. Oxford Region Controlled Trial of Artificial Ventilation OCTAVE Study Group. Multicentre randomised controlled trial of high against low frequency positive pressure ventilation. Arch Dis Child. 1991;66:770–5.
    1. Bernstein G, Mannino FL, Heldt GP, et al. Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. J Pediatr. 1996;128:453–63.
    1. Chen JY, Ling UP, Chen JH. Comparison of synchronized and conventional intermittent mandatory ventilation in neonates. Acta Paediatr Japonica. 1997;39:578–83.
    1. Patel DS, Rafferty GF, Lee S, Hannam S, Greenough A. Work of breathing during SIMV with and without pressure support. Arch Dis Child. 2009;94:434–6.
    1. Tokioka H, Nagano O, Ohta Y, Hirakawa M. Pressure support ventilation augments spontaneous breathing with improved thoracoabdominal synchrony in neonates with congenital heart disease. Anesth Analg. 1997;85:789–93.
    1. Olsen SL, Thibeault DW, Truog WE. Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation. J Perinatol. 2002;22:461–6.
    1. Keszler M, Abubakar KM, Mammel MC. Response to Olsen, et al. Study comparing SIMV and PSV. J Perinatol. 2003;23:434–5.
    1. Patel DS, Rafferty GF, Hannam S, Lee S, Milner AD, Greenough A. In vitro assessment of proportional assist ventilation. Arch Dis Child. 2010 [Epub ahead of print]
    1. Breatnach C, Conlon NP, Stack M, Healy M, O'Hare BP. A prospective crossover comparison of neurally adjusted ventilatory assist and pressure-support ventilation in a pediatric and neonatal intensive care unit population. Pediatr Crit Care Med. 2010;11:7–11.
    1. Zhu LM. Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease. Zhongguo Dang Dai Er Ke Za Zhi. 2009;11:433–6.
    1. Sharma A, Milner AD, Greenough A. Performance of neonatal ventilators in volume targeted ventilation mode. Acta Paediatr. 2007;96:176–80.
    1. The Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.
    1. Pelosi P, Negrini D. Extracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma? Curr Opin Crit Care. 2008;14:16–21.
    1. Umenai T, Shime N, Hashimoto S. Hyperventilation versus standard ventilation for infants in postoperative care for congenital heart defects with pulmonary hypertension. J Anesth. 2009;23:80–6.
    1. Lista G, Castoldi F, Fontana P, et al. Lung inflammation in preterm infants with respiratory distress syndrome: effects of ventilation with different tidal volumes. Pediatr Pulmonol. 2006;41:357–63.
    1. Patel D, Sharma A, Prendergast M, Rafferty GF, Greenough A. Work of breathing and different levels of volume-targeted ventilation. Pediatrics. 2009;123:e679–84.
    1. Pokora T, Bing D, Mammel M, Boros S. Neonatal high-frequency jet ventilation. Pediatrics. 1983;72:27–32.
    1. Boros SJ, Mammel MC, Coleman JM, et al. Neonatal high-frequency jet ventilation: four years' experience. Pediatrics. 1985;75:657–63.
    1. Spitzer AR, Butler S, Fox WW. Ventilatory response to combined high frequency jet ventilation and conventional mechanical ventilation for the rescue treatment of severe neonatal lung disease. Pediatr Pulmonol. 1989;7:244–50.
    1. Friedlich P, Subramanian N, Sebald M, Noori S, Seri L. Use of high-frequency jet ventilation in neonates with hypoxemia refractory to high-frequency oscillatory ventilation. J Matern Fetal Neonatal Med. 2003;13:398–402.
    1. Carlo WA, Beoglos A, Chatburn RL, Walsh MC, Martin RJ. High-frequency jet ventilation in neonatal pulmonary hypertension. Am J Dis Child. 1989;143:233–8.
    1. Baumgart S, Hirschl RB, Butler SZ, Coburn CE, Spitzer AR. Diagnosis-related criteria in the consideration of extracorporeal membrane oxygenation in neonates previously treated with high-frequency jet ventilation. Pediatrics. 1992;89:491–4.
    1. Engle WA, Yoder MC, Andreoli SP, Darragh RK, Langefeld CD, Hui SL. Controlled prospective randomized comparison of high-frequency jet ventilation and conventional ventilation in neonates with respiratory failure and persistent pulmonary hypertension. J Perinatol. 1997;17:3–9.
    1. Kohelet D, Perlman M, Kirpalani H, Hanna G, Koren G. High-frequency oscillation in the rescue of infants with persistent pulmonary hypertension. Crit Care Med. 1988;16:510–6.
    1. Carter J, Gerstmann DR, Clark RH, et al. High-frequency oscillatory ventilation and extracorporeal membrane oxygenation for the treatment of acute neonatal respiratory failure. Pediatrics. 1990;85:159–64.
    1. Clark RH, Yoder BA, Sell MS. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr. 1994;124:447–54.
    1. Rojas MA, Lozano JM, Rojas MX, et al. Randomized, multicenter trial of conventional ventilation versus high-frequency oscillatory ventilation for the early management of respiratory failure in term or near-term infants in Colombia. J Perinatol. 2005;25:720–4.
    1. Henderson-Smart DJ, De Paoli AG, Clark RH, Bhuta T. High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev. 2009;3:CD002974.
    1. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev. 2006;4:CD000399.
    1. Van Meurs K, Peek G, Zwischenberger JB. 3rd ed. Ann Arbor, MI: Extracorporeal Life Support Organisation; 2005. ECMO Extracorporeal Cardiopulmonary Support in Critical Care.
    1. UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet. 1996;348:75–82.
    1. Elbourne D, Field D, Mugford M. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev. 2002;1:CD001340.
    1. UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow up to age 4 years. Lancet. 2001;357:1094–6.
    1. UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow up to age 7 years. Pediatrics. 2006;117:e845–54.
    1. Wolfson MR, Shaffer TH. Pulmonary applications of perfluorochemical liquids: ventilation and beyond. Paediatr Respir Rev. 2005;6:117–27.
    1. Hirschl RB Pranikoff T, Gauger P, Schreiner RJ, Dechert R, Bartlett RH. Liquid ventilation in adults, children, and full-term neonates. Lancet. 1995;346:1201–2.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir