Abstract
Objective: To determine the level of volume targeting (VT) associated with the lowest work of breathing (WOB) for prematurely born infants being ventilated with acute respiratory distress.
Design: Prospective study.
Setting: Tertiary neonatal intensive care unit.
Patients: 18 infants, median gestational age 29 (range 25–34) weeks, being ventilated for acute respiratory distress.
Interventions: Infants were studied first without VT (baseline). Volume targeted levels of 4 ml/kg, 5 ml/kg and 6 ml/kg were then delivered in random order. After each VT level, the infants were returned to baseline. Each step was maintained for 20 minutes.
Main outcome measure: The transdiaphragmatic pressure time product (PTPdi) as an estimate of the WOB.
Results: The mean PTPdi was higher at a VT level of 4 ml/kg (median 154 cm H2O·s/min) compared to baseline (median 112 cm H2O·s/min) (p<0.001) and a VT level of 6 ml/kg (median 89 cm H2O·s/min) (p<0.001).
Conclusion: A low level of VT increased the WOB in infants with acute respiratory distress syndrome. The authors' results suggest that, during acute respiratory distress, a VT level of at least 5 ml/kg rather than a lower level might avoid an increased WOB. The most appropriate level of VT needs to be determined in a randomised controlled trial with long-term outcomes.
Design: Prospective study.
Setting: Tertiary neonatal intensive care unit.
Patients: 18 infants, median gestational age 29 (range 25–34) weeks, being ventilated for acute respiratory distress.
Interventions: Infants were studied first without VT (baseline). Volume targeted levels of 4 ml/kg, 5 ml/kg and 6 ml/kg were then delivered in random order. After each VT level, the infants were returned to baseline. Each step was maintained for 20 minutes.
Main outcome measure: The transdiaphragmatic pressure time product (PTPdi) as an estimate of the WOB.
Results: The mean PTPdi was higher at a VT level of 4 ml/kg (median 154 cm H2O·s/min) compared to baseline (median 112 cm H2O·s/min) (p<0.001) and a VT level of 6 ml/kg (median 89 cm H2O·s/min) (p<0.001).
Conclusion: A low level of VT increased the WOB in infants with acute respiratory distress syndrome. The authors' results suggest that, during acute respiratory distress, a VT level of at least 5 ml/kg rather than a lower level might avoid an increased WOB. The most appropriate level of VT needs to be determined in a randomised controlled trial with long-term outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | F443 - F446 |
| Number of pages | 4 |
| Journal | Archives of Disease in Childhood Fetal and Neonatal Edition |
| Volume | 95 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Nov 2010 |
Keywords
- Prospective Studies
- Work of Breathing
- Humans
- Respiratory Distress Syndrome, Newborn
- Infant, Newborn
- Intensive Care, Neonatal
- Intermittent Positive-Pressure Ventilation
- Infant, Premature
- Male
- Female