Original Article

Journal of Perinatology (2005) 25, 193–197. doi:10.1038/sj.jp.7211233 Published online 27 January 2005

Is there an Advantage of Using Pressure Support Ventilation with Volume Guarantee in the Initial Management of Premature Infants with Respiratory Distress Syndrome? A pilot study

The study was supported in part by a fellowship grant "Advancing Newborn Medicine" to Suhas M. Nafday from Forest Pharmaceuticals Inc. No products from the company were used during this study.

Suhas M Nafday MD, MRCP (Ire.)1,3, Robert S Green MD1, Jing Lin MD1, Luc P Brion MD2, Ian Ochshorn RRT1 and Ian R Holzman MD1

  1. 1Division of Newborn Medicine (S.M.N., R.S.G., J.L., I.O., I.R.H.), Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA
  2. 2Section of Neonatology (L.P.B.), Children's Hospital at Montefiore/Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA

Correspondence: Suhas M. Nafday, MD, Albert Einstein College of Medicine — Children's Hospital at Montefiore, Weiler Division, 1825 Eastchester Road, Suite # 725, Bronx, NY 10461, USA

3S.M.N. is currently working at the Children's Hospital at Montefiore/Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.

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Abstract

OBJECTIVE:

 

To evaluate the feasibility of using the pressure support ventilation with volume guarantee (PSV-VG) as an initial ventilatory mode in preterm infants with respiratory distress syndrome (RDS) after surfactant treatment to achieve accelerated weaning of peak inspiratory pressure (PIP) and mean airway pressure (MAP).

STUDY DESIGN:

 

Initial 24-hour ventilatory parameters were compared in two groups of preterm infants managed by PSV-VG and the synchronized intermittent mandatory ventilation (SIMV) mode in a randomized controlled pilot study after surfactant treatment for RDS. A total of 16 babies were randomized to PSV-VG (1198plusminus108 g [meanplusminusSEM]; 27.9plusminus0.6 weeks) and 18 babies to SIMV (birth weight 1055plusminus77 g; gestational age 27.4plusminus0.5 weeks). Repeated measures analysis of variance was used to compare serial values of PIP and MAP in the two groups.

RESULTS:

 

The PIP and MAP decreased over time (p<0.001) during the first 24 hours after surfactant administration in both groups but the decrease in MAP was faster in the SIMV group compared to PSV-VG group (p=0.035). The median numbers of blood gases during the first 24 hours were four and two in the SIMV and PSV-VG groups, respectively (p<0.001). The overall outcomes were not significantly different between the two groups.

CONCLUSION:

 

PSV-VG did not offer any ventilatory advantage over SIMV in the initial management of surfactant-treated premature newborns with RDS except for minimizing the number of blood gases.