Optimisation of neonatal ventilation

• Main Author: Shetty, Sandeep Krishnanand
• Other Authors: Greenough, Anne ; Rafferty, Gerrard Francis
• Published: King's College London (University of London) 2018
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.754973

Background: Survival of neonates requiring respiratory support has improved over the last two decades, but unfortunately many suffer morbidity from ventilator related complications. Aim: To undertake a series of studies using physiological measurements as outcomes in infants with evolving or established bronchopulmonary dysplasia (BPD) to test the following hypotheses and carry out a national survey. Hypotheses: Proportional assist ventilation (PAV) compared to assist control ventilation (ACV) would improve oxygenation as assessed by the oxygenation index (OI). Neurally adjusted ventilatory assist (NAVA) compared to ACV would improve oxygenation. Use of heated, humidified, high flow nasal cannula (HHFNC) would not have increased given the results of recent randomised trials. Continuous positive airway pressure (CPAP) would reduce the work of breathing (WOB) and thoraco-abdominal asynchrony (TAA) and improve oxygen saturation (SaO2) compared to HHFNC. Methods: Four studies were undertaken. The OI was calculated from measurement of blood gases and the level of respiratory support. A survey was undertaken of lead practitioners in all UK neonatal units. The WOB was assessed by measurement of the pressure time product of the diaphragm (PTPdi) and TAA using respiratory inductance plethysmography (RIP).