Abstract
Objectives
We investigated the inflating pressures (Pinfl, the difference between peak inspiratory pressure and positive end-expiratory pressure) in infants receiving volume targeted ventilation.
Methods
Data were collected and analysed from 195 infants. Median Pinfl was determined before each blood gas (n = 3425). Ventilator parameters and blood gases were compared between periods when Pinfl was <5 mbar and periods when it was higher.
Results
1-hour periods when median Pinfl was <5 mbar occurred in 30% of the babies and were associated with similar tidal volumes and minutes ventilation as periods with higher Pinfl. Babies triggered more ventilator inflations, had more spontaneous breaths and lower oxygen requirement when Pinfl was low. There was no difference in blood gases when Pinfl was <5 mbar or when it was higher.
Conclusions
Episodes of low inflating pressure occur frequently in babies receiving volume targeted ventilation, but they do not lead to changes in blood gases.
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Data availability
Notebooks containing the Python code and explaining all steps of data processing and analysis have been uploaded to a GitHub code repository and are available at https://github.com/gbelteki/VG_minimal_inflating_pressure. Ventilator data are available from the corresponding author upon reasonable request and subject to research ethics committee approval.
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Acknowledgements
We thank to Thomas Krueger, Kreske Brunckhorst and the engineers of Dräger Medical for help to export data from the ventilator. We thank to Professor Colin Morley and Dr Amanda Ogilvy-Stuart for her advice and comments on the manuscript.
Funding
This project has been indirectly supported by the National Institute of Health and Care Research, UK (NIHR).
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Authors and Affiliations
Contributions
GB has designed the study, collected the ventilator data and performed the data analysis. VB and AJ participated in data analysis and interpretation. GB and VB wrote the paper. All authors approved the final version prior to submission.
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Competing interests
GB is a consultant to Vyaire Medical (Mettawa, IL, US) and Dräger Medical (Lübeck, Germany) and received payment for lectures and expert advice. Companies had no role in this study, preparation or approval of this manuscript and have not provided payment for this work. VB and AJ declare no conflict of interest.
Ethical approval and consent to participate
The study was approved by the Bromley (London) Research Ethics Committee of the Health Research Authority of the United Kingdom (reference: 18/LO/2182). Informed consent was gained from parents. All procedures were performed in accordance with the ethical standards of the amended Helsinki Declaration (1983).
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Balog, V., Jermendy, A. & Belteki, G. Low inflating pressures during neonatal tidal volume targeted ventilation: occurrence and significance. J Perinatol 43, 1474–1480 (2023). https://doi.org/10.1038/s41372-023-01695-4
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DOI: https://doi.org/10.1038/s41372-023-01695-4
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