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Volume guarantee ventilation in neonates treated with hypothermia for hypoxic-ischemic encephalopathy during interhospital transport

Journal of Perinatology volume 41, pages 528–534 (2021)Cite this article

Subjects

Abstract

Objective

We investigated if volume guarantee (VG) ventilation in babies with hypoxic-ischemic encephalopathy (HIE) during interhospital transport decreases tidal volumes and prevents hypocapnia.

Study design

We computationally collected and analyzed ventilator data of babies ventilated with synchronized intermittent mandatory ventilation (SIMV) with VG (n = 28) or without VG (n = 8).

Result

The expiratory tidal volume of ventilator inflations was lower with SIMV-VG (median [IQR]: 4.9 [4.6–5.3] mL/kg) than with SIMV only (median [IQR]: 7.1 [5.3–8.0] mL/kg, p = 0.01). Babies receiving SIMV-VG had lower peak inflating pressures (median: 10.7 cmH2O, versus 17.5 cmH2O, p = 0.01). There was no significant difference in minute ventilation or in pCO2. Babies with strong spontaneous breathing had a mean PIP < 10 cmH2O but this did not result in adverse events or worsening of acidosis.

Conclusions

The use of VG ventilation in babies with HIE reduces tidal volumes and frequently results in very low inflating pressures without affecting pCO2.

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Fig. 1: Pearson’s correlation between the infants’ contribution to the total minute ventilation (MV) and the mean peak inflating pressure (PIP) during the transport in infants receiving SIMV-VG ventilation.
Fig. 2: Comparison of ventilator parameters and blood gases in babies receiving SIMV-VG ventilation during transport with mean PIP < 10 cmH2O and >10 cmH2O.

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Acknowledgements

We thank to Roland Hotz, Rainer Kühner, and the engineers of Acutronic for their help to export data from the Fabian ventilator. We thank to Dr Amanda Ogilvy-Stuart for her advice and comments on the paper.

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Authors and Affiliations

  1. Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary

    Lajos Lantos, Aniko Berenyi, Zsolt Somogyvari & Gusztav Belteki

  2. Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Lajos Lantos, Colin Morley & Gusztav Belteki

Authors
  1. Lajos Lantos
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  2. Aniko Berenyi
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  3. Colin Morley
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  4. Zsolt Somogyvari
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  5. Gusztav Belteki
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Contributions

GB designed the study, wrote the computer programs to analyze ventilator data, performed the data analysis, and drafted the paper. LL, AB, and ZS performed the neonatal transfers and collected the clinical data. CJM helped with interpreting the findings. All authors revised and approved the final paper.

Corresponding author

Correspondence to Gusztav Belteki.

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The authors declare that they have no conflict of interest.

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Lantos, L., Berenyi, A., Morley, C. et al. Volume guarantee ventilation in neonates treated with hypothermia for hypoxic-ischemic encephalopathy during interhospital transport. J Perinatol 41, 528–534 (2021). https://doi.org/10.1038/s41372-020-00823-8

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