Article (Scientific journals)
Precision of continuous neonatal ventilator respiratory mechanics is improved with selected optimal respiratory cycles.
RIGO, Vincent; Graas, Estelle; RIGO, Jacques
2012In European Journal of Pediatrics, 171 (4), p. 689-96
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Keywords :
Mechanical ventilation monitoring; Tidal volume; Newborn infant; Compliance; Respiratory mechanics; C20/C
Abstract :
[en] Given their high apparent variability, bedside continuous respiratory mechanics (RM) parameters (excepting tidal volume (VT)) remain infrequently used for adjustment of neonatal ventilatory settings. RM parameters provided by ventilator (VRC) from 10 recordings of newborns (10 minutes in synchronized intermittent mandatory ventilation and Assist/control (A/C)) were compared to those computed from visually selected assisted leak-free optimal respiratory cycles (SRC). Mean values, variability and ability to distinguish patients were compared between VRC and SRC. Dynamic resistances were more correlated (r²=0.95) than compliances (r²=0.42). VT’s were correlated only in A/C (r²=0.78). C20/C was significantly higher in VRC (1.81±0.67) than in SRC (1.23±0.36) and frequently out of neonatal reference range. In A/C ventilation, VT was higher in VRC (5.6 ±1.8 ml/kg) than in SRC (4.8 ±1.0 ml/kg) (p<0.05). Displayed VT’s don’t reflect those found in optimal assisted breaths and therefore have incomplete value in assessing adequacy of ventilator settings. The variability of RM parameters provided by the ventilator is large, and coefficients of variation were significantly lower with optimal respiratory cycles (for Resistance, Compliance, VT and C20/C: 27, 26, 18, 24% in SRC, 36, 35, 40, 33% in VRC). Selecting optimal cycles yields RM with a 2-3 times higher discriminating power between patients. Conclusion: Current ventilator’s RM parameters have limited clinical use. Using optimal breaths to calculate RM parameters improves precision and discriminating power. For integration to ventilatory care, automation of this selection must be implemented first.
Disciplines :
Pediatrics
Author, co-author :
RIGO, Vincent  ;  Centre Hospitalier Universitaire de Liège - CHU > Néonatologie CHR
Graas, Estelle;  Nomics, Liège
RIGO, Jacques ;  Centre Hospitalier Universitaire de Liège - CHU > Néonatologie CHR
Language :
English
Title :
Precision of continuous neonatal ventilator respiratory mechanics is improved with selected optimal respiratory cycles.
Publication date :
April 2012
Journal title :
European Journal of Pediatrics
ISSN :
0340-6199
eISSN :
1432-1076
Publisher :
Springer, Berlin, Germany
Volume :
171
Issue :
4
Pages :
689-96
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 10 June 2012

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