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Low inflating pressures during neonatal tidal volume targeted ventilation: occurrence and significance

Journal of Perinatology volume 43, pages 1474–1480 (2023)Cite this article

Subjects

Abstract

Objectives

We investigated the inflating pressures (Pinfl, the difference between peak inspiratory pressure and positive end-expiratory pressure) in infants receiving volume targeted ventilation.

Methods

Data were collected and analysed from 195 infants. Median Pinfl was determined before each blood gas (n = 3425). Ventilator parameters and blood gases were compared between periods when Pinfl was <5 mbar and periods when it was higher.

Results

1-hour periods when median Pinfl was <5 mbar occurred in 30% of the babies and were associated with similar tidal volumes and minutes ventilation as periods with higher Pinfl. Babies triggered more ventilator inflations, had more spontaneous breaths and lower oxygen requirement when Pinfl was low. There was no difference in blood gases when Pinfl was <5 mbar or when it was higher.

Conclusions

Episodes of low inflating pressure occur frequently in babies receiving volume targeted ventilation, but they do not lead to changes in blood gases.

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Fig. 1: Boxplots showing the distribution of the median inflating pressure (Pinfl = PIP – PEEP) over different periods before blood gases.

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Data availability

Notebooks containing the Python code and explaining all steps of data processing and analysis have been uploaded to a GitHub code repository and are available at https://github.com/gbelteki/VG_minimal_inflating_pressure. Ventilator data are available from the corresponding author upon reasonable request and subject to research ethics committee approval.

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Acknowledgements

We thank to Thomas Krueger, Kreske Brunckhorst and the engineers of Dräger Medical for help to export data from the ventilator. We thank to Professor Colin Morley and Dr Amanda Ogilvy-Stuart for her advice and comments on the manuscript.

Funding

Funding

This project has been indirectly supported by the National Institute of Health and Care Research, UK (NIHR).

Author information

Authors and Affiliations

  1. 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary

    Vera Balog & Agnes Jermendy

  2. Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Gusztav Belteki

Authors
  1. Vera Balog
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  2. Agnes Jermendy
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  3. Gusztav Belteki
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Contributions

GB has designed the study, collected the ventilator data and performed the data analysis. VB and AJ participated in data analysis and interpretation. GB and VB wrote the paper. All authors approved the final version prior to submission.

Corresponding author

Correspondence to Gusztav Belteki.

Ethics declarations

Competing interests

GB is a consultant to Vyaire Medical (Mettawa, IL, US) and Dräger Medical (Lübeck, Germany) and received payment for lectures and expert advice. Companies had no role in this study, preparation or approval of this manuscript and have not provided payment for this work. VB and AJ declare no conflict of interest.

Ethical approval and consent to participate

The study was approved by the Bromley (London) Research Ethics Committee of the Health Research Authority of the United Kingdom (reference: 18/LO/2182). Informed consent was gained from parents. All procedures were performed in accordance with the ethical standards of the amended Helsinki Declaration (1983).

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Balog, V., Jermendy, A. & Belteki, G. Low inflating pressures during neonatal tidal volume targeted ventilation: occurrence and significance. J Perinatol 43, 1474–1480 (2023). https://doi.org/10.1038/s41372-023-01695-4

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  • DOI: https://doi.org/10.1038/s41372-023-01695-4

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