Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation

Abstract

Objective: To compare pressure support ventilation (PSV) with volume guarantee (VG) to synchronized intermittent mandatory ventilation (SIMV) in infants with respiratory distress syndrome (RDS).

Study design: A randomized, crossover study design was used. We enrolled 14 infants [BW (mean+/-SD) 2.5+/-0.7 kg, GA 34+/-2 weeks, age 49+/-26 hours]. Subjects received 4 hours of each mode of ventilation, with the first mode selected randomly. End expiratory volume (EEV) was measured during both ventilatory modes.

Results: Minute ventilation was greater with PSV+VG than with SIMV (p=0.012). This occurred despite no difference in p(a)CO(2). Mean airway pressure was higher during PSV+VG (p=0.023). There was no difference in the arterial/alveolar oxygen tension (a/A) ratio or in the specific dynamic compliance (sCdyn).

Conclusion: Because of an increase in V(E) with PSV+VG, and no difference in the a/A ratio or sCdyn, we do not recommend the routine use of PSV+VG for this population.