DiBlasi Robert M, Crotwell Dave N, Poli Jonathan, Hotz Justin, Cogen Jonathan D, Carter Edward
Center for Developmental Therapeutics, Seattle Children's Research Institute, Seattle, WA, USA.
Respiratory Care Department, Seattle Children's Hospital, Seattle, WA, USA.
Can J Respir Ther. 2018 Spring;54(1):6-11. doi: 10.29390/cjrt-2018-001. Epub 2018 May 1.
This study was designed to evaluate short-term physiologic outcomes of transitioning neonates with bronchopulmonary dysplasia (BPD) from intensive care unit (ICU) ventilators to both the Trilogy 202 (Philips Healthcare, Andover, MA) and LTV 1200 (CareFusion, Yorba Linda, CA) subacute ventilators.
Six infants with BPD requiring tracheostomies for support with a neonatal-specific ICU ventilator underwent placement of esophageal balloon catheters, airway pressure transducers, flow sensors, oxygen saturation (SpO), and end tidal carbon dioxide (PCO) monitors. Noninvasive gas exchange, airflow, and airway and esophageal pressures (P) were recorded following 20 min on the ICU ventilator. The infants were placed on the Trilogy 202 and LTV 1200 ventilators in random order at identical settings as the ICU ventilator. We measured noninvasive gas exchange, pressure-rate product (respiratory rate × ΔP), ventilator response times, and the percentage of spontaneous breaths that triggered the ventilator at 20 min in each subject while being supported with each of the different subacute ventilators.
The mean (SD) weight of the six infants was 4.983 (0.56) kg. There were no differences in heart rate ( = 0.51) or SpO ( = 0.97) but lower PCO, ΔP, respiratory rate, pressure rate-product, response times, and greater percentage of subject initiated breaths that triggered the ventilator ( < 0.05) was observed with the Trilogy 202 than the LTV 1200. All six infants transitioned successfully from the ICU ventilator to the Trilogy 202 ventilator.
In this small group of infants with BPD, the Trilogy 202 ventilator performed better than the LTV 1200. The improved subject efforts, per cent subject triggering, and response times observed with the Trilogy are likely related to differences in triggering algorithms, location of triggering mechanisms, and gas delivery system performance within the ventilators. These pilot data may be useful for informing future clinical study design and understanding differences in the level of support provided by different subacute ventilators in infants with BPD.
本研究旨在评估支气管肺发育不良（BPD）新生儿从重症监护病房（ICU）呼吸机过渡到Trilogy 202（飞利浦医疗保健公司，安多弗，马萨诸塞州）和LTV 1200（CareFusion公司，约巴林达，加利福尼亚州）亚急性呼吸机的短期生理结果。
6名因需要气管切开术并使用新生儿专用ICU呼吸机进行支持的BPD婴儿接受了食管气囊导管、气道压力传感器、流量传感器、血氧饱和度（SpO）和呼气末二氧化碳（PCO）监测仪的放置。在ICU呼吸机上使用20分钟后，记录无创气体交换、气流以及气道和食管压力（P）。婴儿被随机顺序置于与ICU呼吸机设置相同的Trilogy 202和LTV 1200呼吸机上。在每个受试者使用不同亚急性呼吸机支持时，我们在20分钟时测量无创气体交换、压力-速率乘积（呼吸频率×ΔP）、呼吸机响应时间以及触发呼吸机的自主呼吸百分比。
6名婴儿的平均（标准差）体重为4.983（0.56）千克。心率（ = 0.51）或SpO（ = 0.97）无差异，但与LTV 1200相比，使用Trilogy4.983（0.56）千克。心率（P = 0.51）或SpO（P = 0.97）无差异，但Trilogy 202的PCO、ΔP、呼吸频率、压力-速率乘积、响应时间较低，且触发呼吸机的自主呼吸百分比更高（P < 0.05）。所有6名婴儿均成功从ICU呼吸机过渡到Trilogy 202呼吸机。
在这一小群BPD婴儿中，Trilogy 202呼吸机的表现优于LTV 1200。Trilogy观察到的自主呼吸努力改善、自主触发百分比和响应时间改善可能与呼吸机内触发算法、触发机制位置和气体输送系统性能的差异有关。这些初步数据可能有助于为未来的临床研究设计提供信息，并了解不同亚急性呼吸机在BPD婴儿中提供的支持水平差异。
