Adaptive mechanical backup ventilation for preterm infants on respiratory assist modes - a pilot study.
BACKGROUND
Mechanical respiratory-assist modes, such as assist/control, low-rate intermittent mandatory ventilation, continuous positive airway pressure, or proportional assist ventilation (PAV), require a continuous respiratory effort. Because of the frequent occurrence of periodic breathing and/or apnea, mechanical backup ventilation must be initiated during episodes of reduced or absent respiratory drive to maintain gas exchange. The common approach to this problem is a regular conventional mechanical ventilation, which is initiated and withdrawn in an "on/off" function.


OBJECTIVE
To develop and evaluate a mechanical backup ventilation mode that is adaptive to the rapidly changing breathing pattern of preterm infants.


METHODS
Prospective randomized clinical crossover trial.


METHODS
Neonatal intensive care unit at the University of Munich, Germany.


METHODS
Preterm infants undergoing PAV.


METHODS
The infants were ventilated with PAV using a newly developed adaptive backup support, with and without pulse-oximetry-guided operation (SpO(2)-sensitive backup). Each infant was ventilated with both modes of backup support on 2 consecutive days, with the sequence randomized.


RESULTS
The analysis on 11 preterm infants showed a statistically significant and clinically relevant reduction of the incidence (33%) and duration of oxygen desaturations (52%) when SpO(2)-sensitive adaptive backup support was used.


CONCLUSIONS
SpO(2)-sensitive adaptive backup proved safe and effective in reducing the incidence and duration of oxygen desaturation in this short-term trial. This technology is potentially applicable to other assisted modalities of ventilation, such as noninvasive nasal ventilation.
Herber-Jonat
Susanne
S
Department of Obstetrics and Gynecology, Division of Neonatology, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. susanne.jonat@med.uni-muenchen.de.
Rieger-Fackeldey
Esther
E
Department of Obstetrics and Gynecology, Division of Neonatology, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Hummler
Helmut
H
Department of Pediatrics, Division of Neonatology and Pediatric Critical Care, University of Ulm, Eythstrasse 25, 89075, Ulm, Germany.
Schulze
Andreas
A
Department of Obstetrics and Gynecology, Division of Neonatology, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome