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A prospective observational pilot study of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a primary mode of ventilation in infants > or = 28 weeks with respiratory distress syndrome (RDS).
The neonates were initially put on assist control mode of ventilation and synchronized intermittent mandatory mode was the main weaning mode in our neonates.
Therapeutic intervention and outcome (N=72) Therapy Frequency, n (%) Mechanical ventilation Yes 67 (93.1) No 5 (6.9) Mode of ventilation (n=67) Conventional mechanical ventilation 67 (100) High-frequency oscillatory ventilation 13 (18.1) Surfactant use Yes 14 (19.4) No 57 (79.1) Sodium bicarbonate infusion Yes 16 (22.2) No 56 (77.8) Inotropic support Yes 38 (52.8) No 34 (47.2) Vasodilators used Magnesium sulphate 12 (16.7) Sildenafil 9 (12.5) Inhaled nitric oxide 0 (0.0) No vasodilator given 50 (69.4) Number of deaths 25 (34.7) Table 4.
We selected the APRV mode as the primary mode of ventilation because of its ability to rapidly correct oxygenation, enable the patient to breathe spontaneously, reduce sedation requirements, improve the ventilation/perfusion (V/Q) ratio and enhance cardiac performance.
It is a mode of ventilation controlled by tidal volume and respiratory frequency as constant parameters, with variable inspiratory pressures.
The new “ultra-lung protective strategy” adopted the use of even lower tidal volumes and pressures to minimize ventilator-induced lung injury.[sup][15] An important dilemma in these patients is the question, “Should we let the lungs collapse or should we try to keep them open?” The details such as the mode of ventilation, breath type, respiratory rate, positive end-expiratory pressure (PEEP), and FiO[sub]2 are still unknown.
inter-hospital), time of transfer, presence or absence of ECG monitoring, presence or absence of blood pressure monitoring, mode of ventilation, airway management, use of inotropes or use of sedatives.
In each mode of ventilation, patient characteristics were kept quite similar in both groups.
Mode of ventilation was changed to assisted pressure control ventilation with inspiratory pressure of 18 cm of H2O and positive end expiratory pressure (PEEP) of 15 cm of H2O.
Synchronised intermittent mandatory ventilation (SIMV) has been the conventional mode of ventilation in many intensive care units (ICUs) around the world for decades.