Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation.
OBJECTIVE
To compare pressure support ventilation (PSV) with volume guarantee (VG) to synchronized intermittent mandatory ventilation (SIMV) in infants with respiratory distress syndrome (RDS).


METHODS
A randomized, crossover study design was used. We enrolled 14 infants [BW (mean+/-SD) 2.5+/-0.7 kg, GA 34+/-2 weeks, age 49+/-26 hours]. Subjects received 4 hours of each mode of ventilation, with the first mode selected randomly. End expiratory volume (EEV) was measured during both ventilatory modes.


RESULTS
Minute ventilation was greater with PSV+VG than with SIMV (p=0.012). This occurred despite no difference in p(a)CO(2). Mean airway pressure was higher during PSV+VG (p=0.023). There was no difference in the arterial/alveolar oxygen tension (a/A) ratio or in the specific dynamic compliance (sCdyn).


CONCLUSIONS
Because of an increase in V(E) with PSV+VG, and no difference in the a/A ratio or sCdyn, we do not recommend the routine use of PSV+VG for this population.
Olsen
Steven L
SL
Department of Pediatrics, Section of Neonatology, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA.
Thibeault
Donald W
DW
Truog
William E
WE
D002245:Carbon Dioxide / Q000097:blood; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D011336:Probability; D011659:Pulmonary Gas Exchange; D012016:Reference Values; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002245:Carbon Dioxide