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Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants

Journal of Perinatology volume 30, pages 479–483 (2010)Cite this article

Abstract

Objective:

A majority of the modalities of synchronized ventilation in preterm infants require the use of flow sensors that can increase dead space and may adversely affect ventilator weaning. The objective of this study was to assess the effects of flow sensor dead space during synchronized intermittent mandatory ventilation (SIMV) weaning in preterm infants.

Study Design:

Twelve preterm infants (gestational age 25±2 weeks, birth weight 705±158 g, age: 31±186 days, SIMV rate: 25±8 breaths min–1, peak inspiratory pressure 18±2 cm H2O, positive end-expiratory pressure: 5±0.5 cm H2O, pressure support: 9±3 cm H2O, fraction of inspired oxygen: 34±6%) underwent two 2.5-h weaning periods during which SIMV rate was reduced twice by 5 breaths min–1 at 30-min intervals as tolerated, with and without reduction of flow sensor dead space, in random sequence. A 30-min baseline was obtained before each weaning period. Dead space was reduced by flushing the flow sensor with a continuous gas leak flow in the endotracheal tube connector.

Result:

Transcutaneous CO2 tension during SIMV weaning periods without and with reduced dead space did not differ from baseline, whereas total minute ventilation and tidal volume were lower during the SIMV weaning period with reduced dead space. Three infants did not tolerate SIMV weaning without while one infant did not tolerate weaning with reduced dead space.

Conclusion:

SIMV weaning elicited a compensatory rise in spontaneous ventilation. When flow sensor dead space was reduced during SIMV weaning, gas exchange was maintained with lower minute ventilation. Instrumental dead space imposes a ventilatory burden during SIMV weaning in small preterm infants.

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Acknowledgements

The study was supported by the University of Miami ‘Project: New Born’ and The Bank of America Charitable Foundation. This study was presented in part at the 2007 meeting of the Society for Pediatric Research.

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Authors and Affiliations

  1. Pontificia Universidad Catolica de Chile, Santiago, Chile

    A Estay

  2. Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA

    N Claure, C D'Ugard, R Organero & E Bancalari

Authors
  1. A Estay
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  2. N Claure
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  3. C D'Ugard
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  4. R Organero
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  5. E Bancalari
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Correspondence to N Claure.

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Competing interests

Drs Claure and Bancalari have a patent unrelated to the material in the present paper. The University of Miami, the assignee for this patent, has a licensing agreement with Cardinal Health, the manufacturer of the ventilators used in this study. Cardinal Health did not support the study or participate in its design, conduction and reporting.

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Estay, A., Claure, N., D'Ugard, C. et al. Effects of instrumental dead space reduction during weaning from synchronized ventilation in preterm infants. J Perinatol 30, 479–483 (2010). https://doi.org/10.1038/jp.2009.187

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