Elimination of ventilator dead space during synchronized ventilation in premature infants |
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Authors: | Claure Nelson D'Ugard Carmen Bancalari Eduardo |
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Affiliation: | Division of Neonatology, Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33101, USA. NClaure@miami.edu |
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Abstract: | BACKGROUND: Mainstream airflow sensors used in neonatal ventilators to synchronize mechanical breaths with spontaneous inspiration and measure ventilation increase dead space and may impair carbon dioxide (CO(2)) elimination. OBJECTIVE: To evaluate a technique consisting of a continuous gas leakage at the endotracheal tube (ETT) adapter to wash out the airflow sensor for synchronization and ventilation monitoring without CO(2) rebreathing in preterm infants. DESIGN: Minute ventilation (V'(E)) by respiratory inductance plethysmography, end-inspiratory and end-expiratory CO(2) by side-stream microcapnography, and transcutaneous CO(2) tension (TcPCO(2)) were measured in 10 infants (body weight, 835+/-244 g; gestational age, 26+/-2 weeks; age, 19+/-9 days; weight, 856+/-206 g; ventilator rate, 21+/-6 beats/min; PIP, 16+/-1 centimeters of water (cmH(2)O); PEEP, 4.2+/-0.4 cmH(2)O; fraction of inspired oxygen (FIo(2)), 0.26+/-0.6). The measurements were made during four 30-minute periods in random order: IMV (without airflow sensor), IMV+Sensor, SIMV (with airflow sensor), and SIMV+Leak (ETT adapter continuous leakage). RESULTS: Airflow sensor presence during SIMV and IMV+Sensor periods resulted in higher end-inspiratory and end-expiratory CO(2), Tcpco(2), and spontaneous V'(E) compared with IMV. These effects were not observed during SIMV+Leak. CONCLUSIONS: The significant physiologic effects of airflow sensor dead space during synchronized ventilation in preterm infants can be effectively prevented by the ETT adapter continuous leakage technique. |
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Keywords: | CO2, Carbon dioxide ETT, Endotracheal tube F smallcaps" >io2, Fraction of inspired oxygen IMV, Intermittent mandatory ventilation IT, Mechanical inspiratory time PIP, Peak inspiratory pressure PEEP, Positive end-expiratory pressure SIMV, Synchronized intermittent mandatory ventilation S smallcaps" >po2, Arterial oxygen saturation Tc smallcaps" >pco2, Transcutaneous carbon dioxide tension Tc smallcaps" >po2, Transcutaneous oxygen tension RR, Respiratory rate VD, Dead space volume VD-Sensor, Flow sensor dead space volume V′E, Minute ventilation VT, Tidal volume |
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