Porównanie dwóch metod synchronizowanej wentylacji mechanicznej u noworodków z zespołem zaburzeń oddychania

*Andrzej Piotrowski, Szymon Bernas, Wojciech Fendler

Summary
Background. We have compared the effectiveness of pressure regulated volume controlled (PRVC) ventilation and synchronized intermittent mandatory ventilation (SIMV) for treatment of preterm neonates with respiratory distress syndrome (RDS).
Material and methods: This prospective, randomised study was conducted in a 14-bed Paediatric Intensive Therapy Unit. Fifty-six infants with RDS, born at 24-32 weeks of gestation, were enrolled. The neonates were randomly assigned to receive either PRVC or SIMV (time cycled, pressure-limited) ventilation. The primary end-point was to achieve at least 12 hours of efficient gas exchange with an F_IO₂Ł 0.25 and peak inspiratory pressures (PIP) Ł 15 cm H₂O, or early extubation. Analysis was performed using the Cox proportional hazard model.
Results: There were no differences in the duration of mechanical ventilation (a median of 5 days in both groups) and crude time to reach respiratory goals. However, after correction for the required initial F_IO₂, which differed between both groups despite randomisation, PRVC was found to be associated with an improved hazard ratio (HR) for reaching respiratory goals when compared to SIMV. Intention-to-treat analysis HR for reaching respiratory goals equalled 2.78 (95% confidence interval – 95% CI 1.50-5.16), and 2.89 (95% CI 1.52-5.51) in favour of PRVC in the protocol analysis.
Conclusion: PRVC ventilation allowed for earlier weaning from mechanical ventilation, compared to SIMV.

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