Arch Dis Child Fetal Neonatal Ed 2000;82:F5-F10 ( January )

International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome

J H Baumer

Department of Paediatrics, Derriford Hospital, Plymouth, Devon PL6 8DH

Correspondence to: Dr J H Baumer

Accepted 1 August 1999

AIMTo compare the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV) in preterm infants ventilated for respiratory distress syndrome (RDS).
METHODSNine hundred and twenty four babies from 22 neonatal intensive care units were assessed. They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome (RDS) for less than 6 hours within 72 hours of birth. The infants were randomly allocated to receive either PTV or IMV. Analysis was on an "intention to treat" basis. Death before discharge home or oxygen therapy at 36 weeks of gestation; pneumothorax while ventilated; cerebral ultrasound abnormality nearest to 6 weeks; and duration of ventilation in survivors were the main outcome measures.
RESULTSThere was no significant difference in outcome between the two groups. Unadjusted rates for death or oxygen dependency at 36 weeks of gestation were 47.4% and 48.7%, for PTV and IMV, respectively; for pneumothorax these were 13.4% and 10.3%; and for cerebral ultrasound abnormality nearest to 6 weeks these were 35.4% and 36.9%. Median duration of ventilation for survivors in both groups was 6 days. Overall, 79% of babies received only their assigned ventilation. PTV babies were more likely to depart from their intended ventilation (27% vs 15%). The trend towards higher pneumothorax rates with PTV occurred only in infants below 28 weeks of gestation (18.8% vs 11.8%).
CONCLUSIONSThere was no observed benefit from the use of PTV, with a trend towards a higher rate of pneumothorax under 28 weeks of gestation. Although PTV has a similar outcome to IMV for treatment of RDS in infants of 28 weeks or more gestation, within 72 hours of birth, it was abandoned more often. It cannot be recommended for infants of less than 28 weeks' gestation with the ventilators used in this study.


Keywords: patient triggered ventilation; respiratory distress syndrome; intermittent positive pressure ventilation

---

© 2000 by Archives of Disease in Childhood
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Claure, N., Bancalari, E. (2007). New modes of mechanical ventilation in the preterm newborn: evidence of benefit. Arch. Dis. Child. Fetal Neonatal Ed. 92: F508-F512 [Full Text]  
• Thome, U H, Carlo, W A, Pohlandt, F (2005). Ventilation strategies and outcome in randomised trials of high frequency ventilation. Arch. Dis. Child. Fetal Neonatal Ed. 90: F466-F473 [Abstract] [Full Text]  
• D'Angio, C. T., Chess, P. R., Kovacs, S. J., Sinkin, R. A., Phelps, D. L., Kendig, J. W., Myers, G. J., Reubens, L., Ryan, R. M. (2005). Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low-Birth-Weight Infants: A Randomized Controlled Trial. Arch Pediatr Adolesc Med 159: 868-875 [Abstract] [Full Text]  
• Greenough, A (2002). Update on modalities of mechanical ventilators. Arch. Dis. Child. Fetal Neonatal Ed. 87: F3-6 [Abstract] [Full Text]  
• Watkinson, M, Tiron, I (2001). Events before the diagnosis of a pneumothorax in ventilated neonates. Arch. Dis. Child. Fetal Neonatal Ed. 85: F201-203 [Abstract] [Full Text]  
• Cheema, I. U., Ahluwalia, J. S. (2001). Feasibility of Tidal Volume-Guided Ventilation in Newborn Infants: A Randomized, Crossover Trial Using the Volume Guarantee Modality. Pediatrics 107: 1323-1328 [Abstract] [Full Text]  
• Luyt, K, Wright, D, Baumer, J H (2001). Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation. Arch. Dis. Child. Fetal Neonatal Ed. 84: 14F-17 [Abstract] [Full Text]  
• MAMMEL, M. C (2000). Mechanical ventilation of the newborn. Arch. Dis. Child. Fetal Neonatal Ed. 83: 224F-224 [Full Text]  
• VISVESHWARA, N (2000). PTV: should it be patient triggered and patient terminated ventilation?. Arch. Dis. Child. Fetal Neonatal Ed. 83: 224F-224 [Full Text]  
• YADAV, M, BAUMER, J H (2000). To trigger or not to trigger?. Arch. Dis. Child. Fetal Neonatal Ed. 83: 224F-224 [Full Text]  
• DONN, S. M, GREENOUGH, A., SINHA, S. K, BAUMER, J H (2000). Patient triggered ventilation. Arch. Dis. Child. Fetal Neonatal Ed. 83: 224F-224 [Full Text]  
• (2000). Other articles noted. Evid. Based Nurs. 3: 106-112 [Full Text]  
• BURMESTER, M., PETROS, A. (2000). Patient triggered ventilation in neonatal respiratory distress syndrome. Arch. Dis. Child. Fetal Neonatal Ed. 83: 160F-160 [Full Text]  

eLetters:

Read all eLetters

Triggered ventilation in neonates

Margarita Burmester, et al.

Fetal Neonatal Ed. Online, 9 May 2000 [Full text]

Re: Triggered ventilation in neonates

JH Baumer

Fetal Neonatal Ed. Online, 2 Jun 2000 [Full text]

'PTV': should it be patient triggered and patient terminated ventilation?

Nadarasa Visveshwara

Fetal Neonatal Ed. Online, 27 Jun 2000 [Full text]

To trigger or not to trigger?

M Yadav

Fetal Neonatal Ed. Online, 5 Jul 2000 [Full text]

Re: 'PTV': should it be patient triggered and patient terminated ventilation?

J H Baumer

Fetal Neonatal Ed. Online, 26 Jul 2000 [Full text]