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Decreased incidence of extra-alveolar air leakage or death prior to air leakage in high versus low rate positive pressure ventilation: results of a randomised seven-centre trial in preterm infants.
- Source :
-
European journal of pediatrics [Eur J Pediatr] 1992 Dec; Vol. 151 (12), pp. 904-9. - Publication Year :
- 1992
-
Abstract
- Two different ventilation techniques were compared in a seven-centre, randomised trial with 181 preterm infants up to and including 32 completed weeks gestational age, who needed mechanical ventilation because of lung disease of any type. Technique A used a constant rate (60 cycles/min), inspiratory time (IT) (0.33s) and inspiratory: expiratory ratio (I:E) (1:2). The tidal and minute volume was only changed by varying peak inspiratory pressure until weaning via continuous positive airway pressure. Technique B used a lower rate (30 cycles/min) with longer IT (1.0 s). The I:E ratio could be changed from 1:1 to 2:1 in case of hypoxaemia. Chest X-rays taken at fixed intervals were evaluated by a paediatric radiologist and a neonatologist unaware of the type of ventilation used in the patients. A reduction of at least 20% in extra-alveolar air leakage (EAL) or death prior to EAL was supposed in infants ventilated by method A. A sequential design was used to test this hypothesis. The null hypothesis was rejected (P = 0.05) when the 22nd untied pair was completed. The largest reduction in EAL (-55%) was observed in the subgroup 31-32 weeks of gestation and none in the most immature group (< 28 weeks). We conclude that in preterm infants requiring mechanical ventilation for any reason of lung insufficiency, ventilation at 60 cycles/min and short IT (0.33 s) significantly reduces EAL or prior death compared with 30 cycles/min and a longer IT of 1 s. We speculate that a further increase in rate and reduction of IT would also lower the risk of barotrauma in the most immature and susceptible infants.
- Subjects :
- Barotrauma etiology
Germany
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases mortality
Lung Diseases mortality
Positive-Pressure Respiration adverse effects
Positive-Pressure Respiration methods
Pulmonary Alveoli physiopathology
Respiration, Artificial adverse effects
Time Factors
Infant, Premature, Diseases therapy
Lung Diseases therapy
Respiration, Artificial methods
Subjects
Details
- Language :
- English
- ISSN :
- 0340-6199
- Volume :
- 151
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- European journal of pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 1473544
- Full Text :
- https://doi.org/10.1007/BF01954127