Abstract
Background: Various techniques of mechanical ventilation can affect cerebral haemodynamics and oxygenation in preterm infants. Few studies have assessed cerebral haemodynamics and oxygenation during different modalities of patient triggered ventilation (PTV) in preterm infants.
Aim: To study cerebral haemodynamics and oxygenation, by Near Infrared Spectroscopy (NIRS) and Echo-Doppler, during SIMV and SIPPV, with and without VG.
Methods: Ten preterms (means±SD: BW=1316±666 g; GA=28.8±4.2 wks) with RDS were studied at 7.7±7.3 days of life, in SIPPV±VG and SIMV±VG, with VG set at 5 ml/kg. Each ventilation modality was used for 30 minutes in a random sequence. Concentration of cerebral oxyhaemoglobin (O2Hb), deoxyhaemoglobin (HHb) and total haemoglobin (tHb) and Tissue Oxygenation Index (TOI) were continuously monitored by NIRS. At the beginning and at the end of each ventilation modality the Resistance Index (RI) in the Anterior Cerebral Artery was assessed by Echo-Doppler. Heart Rate (HR), Respiratory Rate (RR), Inspired Oxygen Concentration (FiO2), transcutaneous oxygen saturation (SaO2) and transcutaneous PCO2 (PtcCO2) were continuously monitored. Mean Airway Pressure (MAP), Mean Arterial Blood Pressure (MABP), Tidal Volume (Vt), and Compliance of the respiratory system (Crs) were measured at 5 minutes intervals. The results were expressed as means ± SD. Differences between the 4 ventilation modalities were considered statistically significant for p <0.05 by the Student's t test for paired values.
Results: O2Hb, HHb, tHb and IR were stable and similar in the 4 ventilation modalities; oscillations never exceeded 5% of baseline values. TOI was always ± 60%. No differences were found in RR, Vt, HR, SaO2 and PtcCO2. Crs was below normal values in all modalities (SIMV=0.5±0.1; SIMV+VG=0.6±0.2; SIPPV=0.4±0.1; SIPPV+VG=0.5±0.1 ml/cmH2O/kg) and was slightly higher in SIMV than in SIPPV (p<0.02).
Conclusions: These preliminary data suggest that acute changes in cerebral haemodynamics and oxygenation and in lung mechanics are minimal during PTV with low VG, irrespective of the type of ventilation used (SIMV or SIPPV ± VG).
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Dotta, A., Crescenzi, F., Campi, F. et al. 202 Cerebral Haemodynamics and Lung Mechanics in Preterm Infants During Synchronized Intermittent Mandatory Ventilation (SIMV) and Synchronized Intermittent Positive Pressure Ventilation (SIPPV), with and Without Volume Guaranteed (VG). Pediatr Res 56, 498 (2004). https://doi.org/10.1203/00006450-200409000-00225
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DOI: https://doi.org/10.1203/00006450-200409000-00225