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The BUR is important!

Journal of Perinatology volume 32, page 734 (2012)Cite this article

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Wheeler et al.1 are to be congratulated for their recent study assessing the importance of the back-up rate (BUR) during assist-control ventilation using volume targeting. They found that using a lower BUR allowed greater patient interaction with the support device in the form of more patient-triggered breaths, with no compromise in gas exchange. Though the study wasn’t powered to assess the impact of this completely, their findings support the notion that more patient-initiated breaths likely will result in less need for peak inspiratory pressure support—in fact, the driving concept for this form of ventilation. Interesting as well, they saw a small but significant decrease in the total respiratory rate when a lower BUR was used, suggesting more and more efficient respiratory pattern.

These findings are not trivial. Though the ventilator itself cannot prevent chronic lung injury, and with surfactant therapy, we are often able to avoid the disasters of patient-ventilator mismatch so common in the pre-computer era; how we use these devices still has an important role in recovery of the lung function. The goal of our respiratory support techniques is to provide necessary patient support with minimal injury, based on optimal ventilator-patient interaction.

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References

  1. Wheeler KI, Morley CJ, Hooper SB, Davis PG . Lower back-up rates improve ventilator triggering during assist-control ventilation: a randomized crossover trial. J Perinatol 2012; 32: 117–122.

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  1. Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, University of Minnesota, St Paul, MN, USA

    M C Mammel & A A Lampland

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  1. M C Mammel
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  2. A A Lampland
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Correspondence to M C Mammel.

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Mammel, M., Lampland, A. The BUR is important!. J Perinatol 32, 734 (2012). https://doi.org/10.1038/jp.2012.43

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