Is there an advantage of using pressure support ventilation with volume guarantee in the initial management of premature infants with respiratory distress syndrome? A pilot study.
OBJECTIVE
To evaluate the feasibility of using the pressure support ventilation with volume guarantee (PSV-VG) as an initial ventilatory mode in preterm infants with respiratory distress syndrome (RDS) after surfactant treatment to achieve accelerated weaning of peak inspiratory pressure (PIP) and mean airway pressure (MAP).


METHODS
Initial 24-hour ventilatory parameters were compared in two groups of preterm infants managed by PSV-VG and the synchronized intermittent mandatory ventilation (SIMV) mode in a randomized controlled pilot study after surfactant treatment for RDS. A total of 16 babies were randomized to PSV-VG (1198+/-108 g [mean+/-SEM]; 27.9+/-0.6 weeks) and 18 babies to SIMV (birth weight 1055+/-77 g; gestational age 27.4+/-0.5 weeks). Repeated measures analysis of variance was used to compare serial values of PIP and MAP in the two groups.


RESULTS
The PIP and MAP decreased over time (p<0.001) during the first 24 hours after surfactant administration in both groups but the decrease in MAP was faster in the SIMV group compared to PSV-VG group (p=0.035). The median numbers of blood gases during the first 24 hours were four and two in the SIMV and PSV-VG groups, respectively (p<0.001). The overall outcomes were not significantly different between the two groups.


CONCLUSIONS
PSV-VG did not offer any ventilatory advantage over SIMV in the initial management of surfactant-treated premature newborns with RDS except for minimizing the number of blood gases.
Nafday
Suhas M
SM
Division of Newborn Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
Green
Robert S
RS
Lin
Jing
J
Brion
Luc P
LP
Ochshorn
Ian
I
Holzman
Ian R
IR
D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D013501:Surface-Active Agents / Q000627:therapeutic use
D013501:Surface-Active Agents