Recent technological advances in signal detection, transduction and processing have enabled the inclusion of pressure support ventilation (PSV) in mechanical ventilators designed for neonatal use. PSV is a ventilatory mode used in spontaneously breathing infants to provide an inspiratory pressure assist to overcome the work of breathing imposed by high resistive endotracheal tubes, the ventilator circuit, and the demand valve. It is pressure triggered, pressure limited, and flow cycled.
PSV was applied to 10 preterm infants with BPD who were ventilator-dependent and could not be weaned on time-cycled ventilation despite maximal medical therapy. Birthweights ranged from 600-2500 g and gestational ages ranged from 24-34 weeks. At the time PSV was instituted weights ranged from 980-2520 g (mean 1525) and postnatal ages averaged 20 days. PSV was provided by the VIP-BIRD Infant/Pediatric ventilator (Bird Products Corp., Palm Springs, CA). All 10 patients responded promptly and were able to be weaned from mechanical ventilation in an average of 7 days (range 4-21). Pulmonary mechanics testing disclosed significant improvement in the inspiratory flow-volume relationship. PSV appears to be not only feasible, but safe and efficacious in this patient population. (Dr. Donn is a Clinical Advisor to Bird Products Corp.)
