PH Jarreau, G Moriette, P Mussat, C Mariette, A Mohanna, A Harf and H Lorino
Service de Medecine Neonatale, Hopital de Port Royal, Paris, France.

During conventional intermittent mandatory ventilation (IMV) in neonates, asynchrony between mechanical and spontaneous breaths is frequent. We tested the hypothesis that patient-triggered ventilation (PTV) reduces the work of breathing (WOB) by providing synchronized assistance for each breath. Accordingly, six intubated preterm infants were studied at the median postnatal age of 34 days while they were being weaned from mechanical ventilation (MV). Patients were ventilated using the Draeger Babylog 8000 (software #3) and studied in four successive modes of MV with a constant level of positive end-expiratory pressure. They were randomly assigned to IMV, PTV with peak inspiratory pressure of either 10 cm H2O (PTV10) or 15 cm H2O (PTV15), and spontaneous ventilation with continuous positive airway pressure. PTV was achieved in the assist/control mode. During PTV, infants adapted their pattern of breathing in response to an increase in tidal volume (median 7.5 ml/kg in IMV versus 8.2 in PTV10 and 8.5 in PTV15, p<0.05) by decreasing their respiratory rate, thus maintaining minute ventilation (439 ml/min/kg in IMV versus 422 in PTV10 and 455 in PTV15, NS) and transcutaneous CO2. WOB fell significantly during PTV compared with its level during IMV (0.81 J/L in IMV versus 0.48 and 0.47 during PTV10 and PTV15, respectively, p<0.05). Power of breathing decreased in the same proportions. These results demonstrate that PTV mode allows reduction of the workload imposed on the respiratory muscles.

This article has been cited by other articles:

				N. Claure and E. Bancalari New modes of mechanical ventilation in the preterm newborn: evidence of benefit Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F508 - F512. [Full Text] [PDF]

				L. S Owen, C. J Morley, and P. G Davis Neonatal nasal intermittent positive pressure ventilation: what do we know in 2007? Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2007; 92(5): F414 - F418. [Abstract] [Full Text] [PDF]

				M. Keszler Pressure Support Ventilation and Other Approaches to Overcome Imposed Work of Breathing NeoReviews, May 1, 2006; 7(5): e226 - e233. [Full Text] [PDF]

				C. T. D'Angio, P. R. Chess, S. J. Kovacs, R. A. Sinkin, D. L. Phelps, J. W. Kendig, G. J. Myers, L. Reubens, and R. M. Ryan Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low-Birth-Weight Infants: A Randomized Controlled Trial Arch Pediatr Adolesc Med, September 1, 2005; 159(9): 868 - 875. [Abstract] [Full Text] [PDF]

				A. von Goedecke, J. Brimacombe, C. Hormann, H. -C. Jeske, A. Kleinsasser, and C. Keller Pressure Support Ventilation Versus Continuous Positive Airway Pressure Ventilation with the ProSealTM Laryngeal Mask Airway: A Randomized Crossover Study of Anesthetized Pediatric Patients Anesth. Analg., February 1, 2005; 100(2): 357 - 360. [Abstract] [Full Text] [PDF]

				S. K Sinha and S. M Donn Weaning from assisted ventilation: art or science? Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2000; 83(1): 64F - 70. [Full Text]

				J H Baumer International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2000; 82(1): 5F - 10. [Abstract] [Full Text]

				P.-H. Jarreau, B. Louis, G. Dassieu, L. Desfrere, P. W. Blanchard, G. Moriette, D. Isabey, and A. Harf Estimation of inspiratory pressure drop in neonatal and pediatric endotracheal tubes J Appl Physiol, July 1, 1999; 87(1): 36 - 46. [Abstract] [Full Text] [PDF]