Assessment of a new valveless infant ventilator

Randomised controlled trial of patient triggered and conventional fast rate ventilation in neonatal respiratory distress syndrome

AIM

To compare patient triggered, with conventional fast rate, ventilation in a randomised controlled trial using the incidence of chronic lung disease as the primary outcome measure.

METHODS

Three hundred and eighty six preterm infants with birthweights from 1000 to 2000 g, and requiring ventilation for respiratory distress syndrome within 24 hours of birth, were randomised to receive either conventional or trigger ventilation with the SLE 2000 ventilator.

RESULTS

There were no significant differences in the incidence of chronic lung disease (28 day and 36 week definitions), death, pneumothorax, intraventricular haemorrhage, number of ventilator days, or length of oxygen dependency between groups.

CONCLUSIONS

Patient triggered ventilation in preterm infants with respiratory distress syndrome is feasible. No significant differences, when compared with conventional fast rate ventilation in important medium and longer term outcome measures, were evident.

The performance of a new valveless ventilator at rates of up to 250 bpm

The efficacy of a new ventilator, incorporating a valveless pneumatic exhalation circuit, at rates of up to 250 bpm was first assessed in the laboratory. Using this ventilator the effect of fast rate ventilation on blood gases of infants with acute respiratory distress was then examined. Infants were studied at three rates: 60, 125 and 250 bpm. Peak inflating and positive end expiratory pressure, inspiratory: expiratory ratio and inspired oxygen were kept constant. The laboratory study demonstrated that as ventilator rate was increased the delivered volume fell, but even at 250 bpm the delivered volume was 7 ml. In the clinical study, oxygenation at 250 bpm was not significantly different from that at 60 bpm, but significantly lower than at 125 pbm. Carbon dioxide levels were significantly lower at 250 bpm that at 60 bpm, but did not differ significantly from that at 125 bpm. We conclude increasing ventilator rate from 125 to 250 bpm is not advantageous for infants ventilated for acute respiratory distress.

Cardiorespiratory effects of conventional and high frequency ventilation in rabbits with bilateral pneumothoraces and surfactant depleted lungs

We compared high frequency ventilation (HFV) to conventional mechanical ventilation (CMV) under normoxic and normocapnic condition in surfactant depleted rabbits with bilateral pneumothoraces. We hypothesized that lower airway pressures would be required with HFV under these conditions. We applied CMV and HFV in 8 anaesthetized rabbits with a prototype ventilator at frequencies of 30, 100, 200, and 300 cycles/min. A positive end-expiratory pressure (PEEP) just below the pressure sufficient to open the air leak from the pneumothoraces was applied at all frequencies. Airway pressures, gas exchange, heart rate, and mean arterial pressure were recorded. Peak airway pressure decreased significantly from 2.50 to 2.10 kPa when the frequency of ventilation was increased from 30 to 300 cycles/min. There were no significant changes in mean airway pressure, PaO2, arterial pH, heart rate, and mean arterial pressure when HFV was compared to CMV. In conclusion, during HFV peak airway pressures measured at the mouth were decreased. Our ability to maintain adequate gas exchange in the face of ongoing pulmonary air leaks may reflect lower alveolar pressures.

Long term trigger ventilation in neonatal respiratory distress syndrome

Experience of using an SLE 2000 neonatal trigger ventilator as the sole means of ventilation in 68 infants with respiratory distress syndrome was reviewed. No death or complication was seen in 22 infants with a birth weight above 1500 g. Forty five infants under 1500 g birth weight including 18 infants between 23 and 28 weeks' gestation were trigger ventilated throughout. Six infants died, four of whom were under 28 weeks' gestation. Two infants under 1500 g birth weight sustained a pneumothorax while being ventilated. Nine of 61 infants (15%) had radiological evidence of pulmonary interstitial emphysema, which was mild in seven infants. Intraventricular haemorrhage occurred in 10 babies under 1500 g, four of these being grade III or IV. Twenty two (48%) of the babies under 1500 g required added oxygen at 28 days. The preliminary clinical experience of this trigger ventilator suggests that it is capable of providing respiratory support from birth to extubation in even the most immature infants with respiratory distress syndrome. A controlled clinical trial is now required to compare the safety and efficacy of patient triggered ventilation with conventional neonatal ventilation.

Airway pressure triggered ventilation for preterm neonates

The usefulness of airway pressure triggered ventilation for the preterm newborn has been assessed using a new patient triggered valveless ventilator, the SLE 2000 infant ventilator (SLE 2000). This ventilator performs well at fast rates with no inadvertent positive end expiratory pressure (PEEP) even at rates of 150 breaths per minute (bpm). The ventilator is triggered by a change in airway pressure equal to or exceeding 0.5 cmH2O. If the infant fails to achieve the change in airway pressure which will trigger the ventilator the infant is ventilated at the back-up rate which is predetermined in conventional mode prior to commencing PTV. Infants were ventilated for one hour on a conventional neonatal ventilator, then for one hour on the SLE 2000 in conventional mode without changing the ventilator settings and finally for one hour on the SLE 2000 in patient triggered mode. Arterial blood gases were checked at the end of each hour. During patient triggered ventilation (PTV) the peak pressure, inspiratory time and inspired oxygen concentration were the same as those used during conventional mode. Simultaneous recordings were made of flow, volume, ventilator and oesophageal pressure change, from this recording the trigger delay during PTV was calculated. The trigger delay, being the time lag from the start of spontaneous inspiration, indicated by the negative deflection in the oesophageal pressure trace, and the onset of the ventilator breath. Thirteen infants were included in the study, median gestational age 32 weeks (range 25-35) and birthweight 1640 g (range 838-3038). All were being ventilated for respiratory distress syndrome (RDS) and were 4 days of age.(ABSTRACT TRUNCATED AT 250 WORDS)