ISSN:
1432-1076
Keywords:
Mechanical ventilation
;
Preterm infant
;
Extra-alveolar air leakage
;
Randomised trial
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Two different ventilation techniques were compared in a seven-centre, randomised trial with 181 preterm infants up to and including 32 completed weeks gestational age, who needed mechanical ventilation because of lung disease of any type. Technique A used a constant rate (60 cycles/min), inspiratory time (IT) (0.33s) and inspiratory: expiratory ratio (I∶E) (1∶2). The tidal and minute volume was only changed by varying peak inspiratory pressure until weaning via continuous positive airway pressure. Technique B used a lower rate (30 cycles/min) with longer IT (1.0s). The I∶E ratio could be changed from 1∶1 to 2∶1 in case of hypoxaemia. Chest X-rays taken at fixed intervals were evaluated by a paediatric radiologist and a neonatologist unaware of the type of ventilation used in the patients. A reduction of at least 20% in extra-alveolar air leakage (EAL) or death prior to EAl was supposed in infants ventilated by method A. A sequential design was used to test this hypothesis. The null hypothesis was rejected (P=0.05) when the 22nd untied pair was completed. The largest reduction in EAL (−55%) was observed in the subgroup 31–32 weeks of gestation and none in the most immature group (〈28 weeks). We conclude that in preterm infants requiring mechanical ventilation for any reason of lung insufficiency, ventilation at 60 cycles/min and short IT (0.33s) significantly reduces EAL or prior death compared with 30 cycles/min and a longer IT of 1s. We speculate that a further increase in rate and reduction of IT would also lower the risk of barotrauma in the most immature and susceptible infants.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01954127
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