Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Neonatal Emergency and Transport Service of the Peter Cerny Foundation, Budapest, Hungary.
Pediatr Crit Care Med. 2019 Dec;20(12):1170-1176. doi: 10.1097/PCC.0000000000002090.
To compare tidal volumes, inflating pressures and other ventilator variables of infants receiving synchronized intermitted mandatory ventilation with volume guarantee during emergency neonatal transport with those of infants receiving synchronized intermitted mandatory ventilation without volume guarantee.
Retrospective observational study.
A regional neonatal emergency transport service.
We enrolled 77 infants undergoing emergency neonatal transfer. Forty-five infants were ventilated with synchronized intermittent mandatory ventilation with volume guarantee and 32 with synchronized intermitted mandatory ventilation without volume guarantee.
Infants received synchronized intermitted mandatory ventilation with or without volume guarantee during interhospital emergency neonatal transport using a Fabian + nCPAP evolution neonatal ventilator (Software Version: 4.0.1; Acutronic Medical Instruments, Hirzel, Switzerland).
We downloaded detailed ventilator data with 0.5 Hz sampling rate. We analyzed data with the Python computer language and its data science packages. The mean expiratory tidal volume of inflations was lower and less variable in infants ventilated with volume guarantee than in babies ventilated without volume guarantee (group median 4.8 vs 6.0 mL/kg; p = 0.001). Babies ventilated with synchronized intermittent mandatory ventilation with volume guarantee had on average lower and more variable peak inflating pressures than babies ventilated without volume guarantee (group median 15.5 vs 19.5 cm H2O;p = 0.0004). With volume guarantee, a lower proportion of the total minute ventilation was attributed to ventilator inflations rather than to spontaneous breaths between inflations (group median 66% vs 83%; p = 0.02). With volume guarantee, babies had fewer inflations with tidal volumes greater than 6 mL/kg and greater than 8 mL/kg (group medians 3% vs 44% and 0% vs 7%, respectively; p = 0.0001). The larger tidal volumes in the non-volume guarantee group were not associated with significant hypocapnia except in one case.
During neonatal transport, synchronized intermittent mandatory ventilation with volume guarantee ventilation reduced the occurrence of excessive tidal volumes, but it was associated with larger contribution of spontaneous breaths to minute ventilation compared with synchronized intermitted mandatory ventilation without volume guarantee.
比较接受有容量保证的同步间歇强制通气（SIMV+VG）与接受无容量保证的同步间歇强制通气（SIMV-UG）的婴儿在接受紧急新生儿转运时的潮气量、充气压力和其他呼吸机变量。
回顾性观察研究。
区域新生儿急救转运服务。
我们纳入了 77 名接受紧急新生儿转运的婴儿。45 名婴儿接受有容量保证的同步间歇强制通气（SIMV+VG），32 名婴儿接受无容量保证的同步间歇强制通气（SIMV-UG）。
使用 Fabian+nCPAP 进化新生儿呼吸机（软件版本：4.0.1；Acutronic Medical Instruments，Hirzel，瑞士）在院内紧急新生儿转运期间对婴儿进行有或无容量保证的同步间歇强制通气。
我们以 0.5Hz 的采样率下载详细的呼吸机数据。我们使用 Python 计算机语言及其数据科学包进行数据分析。有容量保证的婴儿充气时的呼气潮气量更低，变异更小（组中位数 4.8 与 6.0ml/kg；p = 0.001）。有容量保证的婴儿的峰值充气压力更低，变异更大（组中位数 15.5 与 19.5cmH2O；p = 0.0004）。有容量保证时，总分钟通气量中呼吸机充气的比例较低，而充气之间的自主呼吸比例较高（组中位数 66%与 83%；p = 0.02）。有容量保证时，婴儿的充气潮气量大于 6ml/kg 和大于 8ml/kg 的次数更少（组中位数 3%与 44%和 0%与 7%；p = 0.0001）。非容量保证组中较大的潮气量除了 1 例外均未导致明显低碳酸血症。
在新生儿转运期间，有容量保证的同步间歇强制通气（SIMV+VG）减少了过度潮气量的发生，但与无容量保证的同步间歇强制通气（SIMV-UG）相比，它与自主呼吸对分钟通气量的贡献更大有关。
