Sandeep Shetty1, Prashanth Bhat2, Ann Hickey3, Janet L Peacock4,5, Anthony D Milner6, Anne Greenough7,8. 1. Neonatal Intensive Care Centre, King's College Hospital, London, UK. sandeep.shetty1@nhs.net. 2. Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London, London, UK. prashanth.bhat@kcl.ac.uk. 3. Neonatal Intensive Care Centre, King's College Hospital, London, UK. annhickey@nhs.net. 4. Division of Health and Social Care Research, King's College London, London, UK. janet.peacock@kcl.ac.uk. 5. NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. janet.peacock@kcl.ac.uk. 6. Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London, London, UK. anthony.milner@kcl.ac.uk. 7. Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King's College London, London, UK. anne.greenough@kcl.ac.uk. 8. NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. anne.greenough@kcl.ac.uk.
Abstract
During proportional assist ventilation (PAV), the applied pressure is servo-controlled based on continuous input from the infant's breathing. In addition, elastic and resistive unloading can be employed to compensate for the abnormalities in the infant's lung mechanics. The aim of this study was to test the hypothesis that in very prematurely born infants remaining ventilated beyond the first week, PAV compared to assist control ventilation (ACV) would be associated with superior oxygenation. A randomised crossover study was undertaken. Infants were studied for 4 hours each on PAV and ACV in random order; at the end of each 4-h period, the oxygenation index (OI) was calculated. Eight infants, median gestational age of 25 (range 24-33) weeks, were studied at a median of 19 (range 10-105) days. It had been intended to study 18 infants but as all the infants had superior oxygenation on PAV (p = 0.0039), the study was terminated after recruitment of eight infants. The median inspired oxygen concentration (p = 0.049), mean airway pressure (p = 0.012) and OI (p = 0.012) were all lower on PAV. CONCLUSION: These results suggest that PAV compared to ACV is advantageous in improving oxygenation for prematurely born infants with evolving or established BPD. WHAT IS KNOWN: During proportional assist ventilation (PAV), the applied pressure is servo controlled throughout each spontaneous breath. Elastic and resistive unloading can compensate for the infant's abnormalities in lung mechanics. WHAT IS NEW: In a randomised crossover study, infants with evolving/established BPD were studied on PAV and ACV each for 4 h. The oxygenation index was significantly lower on PAV in all infants studied.
During proportional assist ventilation (PAV), the applied pressure is servo-controlled based on continuous input from the infant's breathing. In addition, elastic and resistive unloading can be employed to compensate for the abnormalities in the infant's lung mechanics. The aim of this study was to test the hypothesis that in very prematurely born infants remaining ventilated beyond the first week, PAV compared to assist control ventilation (ACV) would be associated with superior oxygenation. A randomised crossover study was undertaken. Infants were studied for 4 hours each on PAV and ACV in random order; at the end of each 4-h period, the oxygenation index (OI) was calculated. Eight infants, median gestational age of 25 (range 24-33) weeks, were studied at a median of 19 (range 10-105) days. It had been intended to study 18 infants but as all the infants had superior oxygenation on PAV (p = 0.0039), the study was terminated after recruitment of eight infants. The median inspired oxygen concentration (p = 0.049), mean airway pressure (p = 0.012) and OI (p = 0.012) were all lower on PAV. CONCLUSION: These results suggest that PAV compared to ACV is advantageous in improving oxygenation for prematurely born infants with evolving or established BPD. WHAT IS KNOWN: During proportional assist ventilation (PAV), the applied pressure is servo controlled throughout each spontaneous breath. Elastic and resistive unloading can compensate for the infant's abnormalities in lung mechanics. WHAT IS NEW: In a randomised crossover study, infants with evolving/established BPD were studied on PAV and ACV each for 4 h. The oxygenation index was significantly lower on PAV in all infants studied.
Entities:
Keywords:
Assist control ventilation; Oxygenation; Proportional assist ventilation
Authors: Deena-Shefali Patel; Gerrard F Rafferty; Simon Hannam; Silke Lee; Anthony D Milner; Anne Greenough Journal: Arch Dis Child Fetal Neonatal Ed Date: 2010-06-07 Impact factor: 5.747
Authors: Marco Piastra; Daniele De Luca; Roberta Costa; Alessandro Pizza; Renata De Sanctis; Laura Marzano; Daniele Biasucci; Federico Visconti; Giorgio Conti Journal: J Crit Care Date: 2013-10-25 Impact factor: 3.425
Authors: Prashanth Bhat; Deena-Shefali Patel; Simon Hannam; Gerrard F Rafferty; Janet L Peacock; Anthony D Milner; Anne Greenough Journal: Arch Dis Child Fetal Neonatal Ed Date: 2014-05-28 Impact factor: 5.747
Authors: Leeann R Pavlek; Brian K Rivera; Charles V Smith; Joanie Randle; Cory Hanlon; Kristi Small; Edward F Bell; Matthew A Rysavy; Sara Conroy; Carl H Backes Journal: J Pediatr Date: 2021-04-21 Impact factor: 6.314