The use of guaranteed volume mode as a form of weaning in mechanical ventilation of premature newborns

Terminated

• Conditions: Respiratory Distress Syndrome, Newborn; M01.060.703.520.520

• Registration Number: RBR-6y2q4d5
• Lead Sponsor: niversidade Federal do Rio Grande do Norte

Brief Summary

Introduction: The diaphragm of preterm newborns is flat, weak, and horizontally inserted in the rib cage. Consequently, it hampers the lever mechanism during muscle contraction, reduces the efficiency of pulmonary ventilation and chest expansion, and increases energy expenditure. Objective: To assess chest expansion using inductance plethysmography in preterm newborns during assist-control ventilation and inspiratory pressure control with and without volume guarantee (VG and AC-PC, respectively). Methods: This is a crossover clinical trial. Ventilatory (peak pressure, minute volume, dynamic compliance, and airway resistance) and autonomic outcomes (heart rate, respiratory rate, and peripheral oxygen saturation) were measured at 0, 30, and 60 minutes after initiation of ventilation. Paired t-test compared ventilation modes and times (0, 30, and 60 minutes). Results: We included ten preterm newborns (mean gestational age of 30 ± 1.89 weeks and weight of 964 ± 167.1 grams). VG increased chest expansion and peripheral oxygen saturation and reduced respiratory distress compared with AC-PC. Conclusion: VG may increase chest expansion and peripheral oxygen saturation and reduce respiratory distress and heart rate compared with AC-CP mode. Also, inductance plethysmography may be viable for measuring chest expansion during mechanical ventilation.

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Completion: 2021-04-10
• Study Start: 2022-10-20
• Last Update Posted: 29 May 2023

Recruitment & Eligibility

• Status: Terminated
• Sex: Not specified
• Target Recruitment: Not specified

Inclusion Criteria

Premature newborns (gestational age equal to or less than 32 weeks), diagnosed with Respiratory Distress Syndrome and birth weight of up to 1,500g, intubated and in a weaning protocol. The protocol maintained an inspired fraction of oxygen lower than 50%, mandatory respiratory rate lower than 30 cycles per minute, peak pressure equal to or lower than 25cmH2O, and end expiratory pressure lower than or equal to 6 centimeters of water.

Exclusion Criteria

Using medications with side effects on the respiratory system were not included and those preterm newborns who presented clinical worsening and/or need to increase ventilatory parameters were excluded.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Expected Outcome 1: It is expected to identify which ventilation modality promotes improvement in chest expansion and allows greater synchrony between the patient and the ventilator.<br>;Outcome 1: It was possible to identify an increase in chest expansion in guaranteed volume mode, indicating a better modality for weaning from ventilation in this population.

Secondary Outcome Measures

Name	Time	Method
Expected Outcome 2: It is expected to evaluate the degree of respiratory distress in the two ventilation modes, in order to identify which of the modes promotes greater comfort for the patient.<br>;Outcome 2: It was possible to observe a lower degree of respiratory discomfort in NBs ventilated at a guaranteed volume through the Silverman-Andersen bulletin.;Expected Outcome 3: It is expected to identify which ventilatory modality offers the least impact on the autonomic variables in the evaluated newborns.;Outcome 3: The guaranteed volume mode was associated with a lower heart rate in newborns under mechanical ventilation.