Work of breathing during SIMV with and without pressure support

D-S Patel, G F Rafferty, S Lee, S Hannam, A Greenough
Archives of Disease in Childhood 2009, 94 (6): 434-6

OBJECTIVE: In a randomised trial, pressure support with synchronised intermittent mandatory ventilation (SIMV) compared to SIMV alone was associated with a significant reduction in supplementary oxygen duration. The hypothesis that the addition of pressure support to SIMV compared to SIMV alone would reduce the work of breathing was examined.

DESIGN: Prospective study.

SETTING: Perinatal service.

PATIENTS: 20 infants, with a mean gestational age of 31 weeks, being weaned from mechanical ventilation were studied.

INTERVENTIONS: 1 h periods of SIMV and SIMV with pressure support at 50% of the difference between the peak inflating pressure and positive end expiratory pressures.

MAIN OUTCOME MEASURES: The work of breathing was assessed by measurement of the transdiaphragmatic pressure time product (PTPdi).

RESULTS: The mean PTPdi on SIMV plus pressure support was 112 cm H(2)Oxs/min, approximately 20% lower than that on SIMV alone (141 cm H(2)Oxs/min) (p<0.001).

CONCLUSION: The addition of pressure support to SIMV reduces the work of breathing in infants being weaned from the ventilator.

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