OBJECTIVES: To assess the importance of synchronization of mechanical ventilation with spontaneous respiratory efforts in mechanically ventilated neonates. The actions of this synchronization on ventilation, oxygenation, and BP variation were assessed. DESIGN: Prospective evaluation using within-subject comparison of asynchronous and synchronous states. SETTING: Neonatal ICU in a large, university-affiliated hospital. PATIENTS: Fourteen neonates requiring mechanical ventilation who were initially asynchronous with the ventilator. INTERVENTION: The ventilator settings were adjusted using the patients' own inspiratory and expiratory timing to create synchronous interaction with the ventilator. MEASUREMENTS AND MAIN RESULTS: Synchrony was assessed using clinical observation combined with inspection of the air flow waveform and computerized analysis of the air flow signal to assess cycle-to-cycle reproducibility, so-called autocorrelation. Synchronous ventilation significantly improved tidal volume (p < .05), minute volume (p < .001), and all indices of the variability of arterial BP (p < .001). Mean airway pressure did not change significantly. No infant developed an airleak syndrome or intraventricular hemorrhage, which have previously been associated with asynchronous ventilation and an unstable BP, respectively. CONCLUSION: Synchronous ventilation can be readily applied to most ventilated neonates. It improves ventilation, and results in a marked reduction in BP variation, which may have implications for reducing the risk of intraventricular hemorrhage.
OBJECTIVES: To assess the importance of synchronization of mechanical ventilation with spontaneous respiratory efforts in mechanically ventilated neonates. The actions of this synchronization on ventilation, oxygenation, and BP variation were assessed. DESIGN: Prospective evaluation using within-subject comparison of asynchronous and synchronous states. SETTING:Neonatal ICU in a large, university-affiliated hospital. PATIENTS: Fourteen neonates requiring mechanical ventilation who were initially asynchronous with the ventilator. INTERVENTION: The ventilator settings were adjusted using the patients' own inspiratory and expiratory timing to create synchronous interaction with the ventilator. MEASUREMENTS AND MAIN RESULTS: Synchrony was assessed using clinical observation combined with inspection of the air flow waveform and computerized analysis of the air flow signal to assess cycle-to-cycle reproducibility, so-called autocorrelation. Synchronous ventilation significantly improved tidal volume (p < .05), minute volume (p < .001), and all indices of the variability of arterial BP (p < .001). Mean airway pressure did not change significantly. No infant developed an airleak syndrome or intraventricular hemorrhage, which have previously been associated with asynchronous ventilation and an unstable BP, respectively. CONCLUSION: Synchronous ventilation can be readily applied to most ventilated neonates. It improves ventilation, and results in a marked reduction in BP variation, which may have implications for reducing the risk of intraventricular hemorrhage.