Work of breathing and different levels of volume-targeted ventilation

TY - JOUR

T1 - Work of breathing and different levels of volume-targeted ventilation

AU - Patel, Deena-Shefali

AU - Sharma, Atul

AU - Prendergast, Michael

AU - Rafferty, Gerrard F

AU - Greenough, Anne

PY - 2009/4

Y1 - 2009/4

N2 - OBJECTIVES. The objectives of this study were to determine the impact of different volume-targeted levels on the work of breathing and to investigate whether a level that reduced the work of breathing below that experienced during ventilatory support without volume targeting could be determined. METHODS. The transdiaphragmatic pressure-time product, as an estimate of the work of breathing, was measured for 20 infants (median gestational age: 28 weeks) who were being weaned from respiratory support by using patient-triggered ventilation (either assist-control ventilation or synchronous intermittent mandatory ventilation). The transdiaphragmatic pressure-time product was measured first without volume targeting (baseline) and then at volume-targeted levels of 4, 5, and 6 mL/kg, delivered in random order. After each volume-targeted level, the infants were returned to baseline. Each step was maintained for 20 minutes. RESULTS. The mean transdiaphragmatic pressure-time product was higher with volume targeting at 4 mL/kg in comparison with baseline, regardless of the patient-triggered mode. The transdiaphragmatic pressure-time product was higher at a volume-targeted level of 4 mL/kg in comparison with 5 mL/kg and at 5 mL/kg in comparison with 6 mL/kg. The mean work of breathing was below that at baseline only at a volume- targeted level of 6 mL/kg. CONCLUSIONS. Low volume- targeted levels increase the work of breathing during volume-targeted ventilation. Our results suggest that, during weaning, a volume-targeted level of 6 mL/kg, rather than a lower level, could be used to avoid an increase in the work of breathing. Pediatrics 2009; 123: e679-e684

AB - OBJECTIVES. The objectives of this study were to determine the impact of different volume-targeted levels on the work of breathing and to investigate whether a level that reduced the work of breathing below that experienced during ventilatory support without volume targeting could be determined. METHODS. The transdiaphragmatic pressure-time product, as an estimate of the work of breathing, was measured for 20 infants (median gestational age: 28 weeks) who were being weaned from respiratory support by using patient-triggered ventilation (either assist-control ventilation or synchronous intermittent mandatory ventilation). The transdiaphragmatic pressure-time product was measured first without volume targeting (baseline) and then at volume-targeted levels of 4, 5, and 6 mL/kg, delivered in random order. After each volume-targeted level, the infants were returned to baseline. Each step was maintained for 20 minutes. RESULTS. The mean transdiaphragmatic pressure-time product was higher with volume targeting at 4 mL/kg in comparison with baseline, regardless of the patient-triggered mode. The transdiaphragmatic pressure-time product was higher at a volume-targeted level of 4 mL/kg in comparison with 5 mL/kg and at 5 mL/kg in comparison with 6 mL/kg. The mean work of breathing was below that at baseline only at a volume- targeted level of 6 mL/kg. CONCLUSIONS. Low volume- targeted levels increase the work of breathing during volume-targeted ventilation. Our results suggest that, during weaning, a volume-targeted level of 6 mL/kg, rather than a lower level, could be used to avoid an increase in the work of breathing. Pediatrics 2009; 123: e679-e684

KW - Ventilator Weaning

KW - Work of Breathing

KW - Humans

KW - Respiratory Distress Syndrome, Newborn

KW - Infant, Newborn

KW - Intensive Care, Neonatal

KW - Infant, Premature

KW - Energy Metabolism

KW - Tidal Volume

U2 - 10.1542/peds.2008-2635

DO - 10.1542/peds.2008-2635

M3 - Article

C2 - 19254970

VL - 123

SP - E679 - E684

JO - Pediatrics

JF - Pediatrics

IS - 4

ER -