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Department of
Paediatrics, Derriford Hospital,
Plymouth, Devon PL6 8DH
Correspondence to: Dr J H Baumer
Accepted 1
August 1999
AIM
To 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.
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M. C MAMMEL Mechanical ventilation of the newborn Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2000; 83(3): 224F - 224. [Full Text]
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N VISVESHWARA PTV: should it be patient triggered and patient terminated ventilation? Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2000; 83(3): 224F - 224. [Full Text]
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M YADAV and J H BAUMER To trigger or not to trigger? Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2000; 83(3): 224F - 224. [Full Text]
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S. M DONN, A. GREENOUGH, S. K SINHA, and J H BAUMER Patient triggered ventilation Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2000; 83(3): 224F - 224. [Full Text]
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M. BURMESTER and A. PETROS Patient triggered ventilation in neonatal respiratory distress syndrome Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2000; 83(2): 160F - 160. [Full Text]
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