REDUCTION OF BAROTRAUMA IN VENTILATED NEONATES BY INCREASE IN VENTILATION FREQUENCY - FIRST RESULTS OF A PROSPECTIVE COLLABORATIVE AND RANDOMIZED TRIAL OF TWO DIFFERENT VENTILATORY TECHNIQUES

Abstract

Two ventilatory techniques were investigated prospectively for the production of extraalveolar air leakage (eal) in a collaborative study from 8 children's hospitals (eal: interstitial emphysema, pneumothorax, -mediastinum, -pericardium, -peritoneum). Ventilated four hours old neonates with normocapnia and an oxygen requirement of 40% or more were entered into the study. Within three gestational age classes (⋜28, 29-30, 31-32 weeks gestation) each subject was randomly assigned either ventilatory technique A or B. A: frequency 60/min, I:E=1:2; ventilation was increased or decreased only by changing ventilatory pressure. B: frequency 30-(40)min, I:E=1:1-(2:1), ventilation could be increased or decreased by changing ventilatory pressure, frequency and (<40 min) I:E ratio (<2:1). Standardized ap chest x-rays were assessed blind for the presence of eal between the 4th and 24th hour of life and on the 3rd, 5th and 7th day of life. A closed sequential test design was used for the statistical analysis.

Results: Pairs without eal =13; pairs with eal =16; pairs with eal using ventilatory technique A =10; pairs with eal using ventilatory technique B =25. By 1/4/85 it was possible to say that ventilatory technique A, which meant a higher ventilation frequency and a lower I:E ratio, causes less eal than B with a probability of error less than 10% and close to 5%.

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