Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 11, November, p. 1325–1329

doi: 10.17219/acem/128198

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Cerebral oxygenation and circulatory parameters during pressure-controlled vs volume-targeted mechanical ventilation in extremely preterm infants

Michalina Bugiera1,B,C,D,F, Tomasz Szczapa1,A,D,E,F, Anna Sowińska2,C,F, Charles Christoph Roehr3,E,F, Marta Szymankiewicz-Bręborowicz1,A,E,F

1 Department of Neonatology, Poznan University of Medical Sciences, Poland

2 Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland

3 Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, United Kingdom

Abstract

Background. Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant.
Objectives. To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO2 in extremely preterm infants.
Material and Methods. This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO2) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO2, and electrical cardiometry (EC) were used in monitoring of the patients.
Results. Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients’ mean postnatal age was 7.7 days. The SpO2 values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC. The circulatory parameters were comparable.
Conclusion. The StO2 is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.

Key words

respiratory distress syndrome, volume-targeted ventilation, preterm infant, cerebral oxygenation, electrical cardiometry

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