How to ventilate preterm infants with lung compliance close to circuit compliance: real-time simulations on an infant hybrid respiratory simulator
Circuit compliance close to lung compliance can create serious problems in effective and safe mechanical ventilation of preterm infants. We considered what ventilation technique is the most beneficial in this case. A hybrid (numerical–physical) simulator of infant respiratory system mechanics, the B...
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Published in | Medical & biological engineering & computing Vol. 58; no. 2; pp. 357 - 372 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.02.2020
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Circuit compliance close to lung compliance can create serious problems in effective and safe mechanical ventilation of preterm infants. We considered what ventilation technique is the most beneficial in this case. A hybrid (numerical–physical) simulator of infant respiratory system mechanics, the Bennett Ventilator and NICO apparatus were used to simulate pressure-controlled ventilation (PC) and volume-controlled ventilation with constant flow (VCV
CF
) and descending flow (VCV
DF
), under permissive hypercapnia (PHC) (6 ml kg
−1
) and normocapnia (SV) (8 ml kg
−1
) conditions. Respiratory rate (RR) was 36 or 48 min
−1
and PEEP was 0.3 or 0.6 kPa. Peak inspiratory pressure (PIP), mean airway pressure (MAP), and work of breathing by the ventilator (WOB) were lower (
P
< 0.01, 1 −
β
= 0.9) using the PHC strategy compared to the SV strategy. The WOB increased (
P
< 0.01; 1 −
β
= 0.9) when the RR increased. The PC, VCV
CF
, and VCV
DF
modes did not differ in minute ventilation produced by the ventilator (MV
V
), but the PC mode delivered the highest minute ventilation to the patient (MV
T
) (
P
< 0.01; 1 −
β
= 0.9) at the same PIP, MAP, and WOB. The most beneficial ventilation technique appeared to be PC ventilation with the PHC strategy, with lower RR (36 min
−1
).
Graphical abstract
The effectiveness of an infant ventilation depending on circuit compliance to lung compliance ratio (C
v
C
L
-1
) and inspiration time (T
i
). V
V
, V
T
, tidal volume set on the ventilator and delivered to patient, respectively |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0140-0118 1741-0444 |
DOI: | 10.1007/s11517-019-02089-5 |