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. 1998 Jan;78(1):F15–F19. doi: 10.1136/fn.78.1.f15

Randomised controlled trial of respiratory system compliance measurements in mechanically ventilated neonates

B Stenson, R Glover, R Wilkie, I Laing, W Tarnow-Mordi
PMCID: PMC1720735  PMID: 9536834

Abstract

AIM—To determine whether outcomes of neonatal mechanical ventilation could be improved by regular pulmonary function testing.
METHODS—Two hundred and forty five neonates, without immediately life threatening congenital malformations, were mechanically ventilated in the newborn period. Infants were randomly allocated to conventional clinical management (control group) or conventional management supplemented by regular measurements of static respiratory system compliance, using the single breath technique, with standardised management advice based on the results.
RESULTS—Fifty five (45%) infants in each group experienced one or more adverse outcomes. The median (quartile) durations of ventilation and oxygen supplementation were 5 (2-12) and 6 (2-34) days for the control group, and 4 (2-9) and 6 (3-36) days for the experimental group (not significant). On post-hoc secondary analysis, control group survivors were ventilated for 1269 days with a median (quartile) of 5 (2-13) days, and experimental group survivors were ventilated for 775 days with a median (quartile) duration of 3 (2-8) days (p=0.03).
CONCLUSIONS—Although primary analysis did not show any substantial benefit associated with regular measurement of static respiratory system compliance, this may reflect a type II error, and a moderate benefit has not been excluded. Larger studies are required to establish the value of on-line monitoring techniques now available with neonatal ventilators.



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Selected References

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  1. Baboolal R., Kirpalani H. Measuring on-line compliance in ventilated infants using hot wire anemometry. Crit Care Med. 1990 Oct;18(10):1070–1072. doi: 10.1097/00003246-199010000-00004. [DOI] [PubMed] [Google Scholar]
  2. Balsan M. J., Jones J. G., Watchko J. F., Guthrie R. D. Measurements of pulmonary mechanics prior to the elective extubation of neonates. Pediatr Pulmonol. 1990;9(4):238–243. doi: 10.1002/ppul.1950090409. [DOI] [PubMed] [Google Scholar]
  3. Dreizzen E., Migdal M., Praud J. P., Magny J. F., Dehan M., Chambille B., Gaultier C. Passive compliance of total respiratory system in preterm newborn infants with respiratory distress syndrome. J Pediatr. 1988 May;112(5):778–781. doi: 10.1016/s0022-3476(88)80702-9. [DOI] [PubMed] [Google Scholar]
  4. Dreizzen E., Migdal M., Praud J. P., Saby M. A., Chambille B., Dehan M., Gaultier C. Passive total respiratory system compliance and gas exchange in newborns with hyaline membrane disease. Pediatr Pulmonol. 1989;6(1):2–7. doi: 10.1002/ppul.1950060104. [DOI] [PubMed] [Google Scholar]
  5. Dreyfuss D., Saumon G. Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med. 1992;18(3):139–141. doi: 10.1007/BF01709236. [DOI] [PubMed] [Google Scholar]
  6. Farrell P. M., Avery M. E. Hyaline membrane disease. Am Rev Respir Dis. 1975 May;111(5):657–688. doi: 10.1164/arrd.1975.111.5.657. [DOI] [PubMed] [Google Scholar]
  7. Field D. J., Milner A. D., Hopkin I. E., Madeley R. J. Changing patterns in neonatal respiratory diseases. Pediatr Pulmonol. 1987 Jul-Aug;3(4):231–235. doi: 10.1002/ppul.1950030407. [DOI] [PubMed] [Google Scholar]
  8. Fisher J. B., Mammel M. C., Coleman J. M., Bing D. R., Boros S. J. Identifying lung overdistention during mechanical ventilation by using volume-pressure loops. Pediatr Pulmonol. 1988;5(1):10–14. doi: 10.1002/ppul.1950050104. [DOI] [PubMed] [Google Scholar]
  9. Gappa M., Rabbette P. S., Costeloe K. L., Stocks J. Assessment of passive respiratory compliance in healthy preterm infants: a critical evaluation. Pediatr Pulmonol. 1993 May;15(5):304–311. doi: 10.1002/ppul.1950150508. [DOI] [PubMed] [Google Scholar]
  10. Gommers D., Vilstrup C., Bos J. A., Larsson A., Werner O., Hannappel E., Lachmann B. Exogenous surfactant therapy increases static lung compliance, and cannot be assessed by measurements of dynamic compliance alone. Crit Care Med. 1993 Apr;21(4):567–574. doi: 10.1097/00003246-199304000-00019. [DOI] [PubMed] [Google Scholar]
  11. Horbar J. D., Wright E. C., Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth. The Members of the National Institute of Child Health and Human Development Neonatal Research Network. Pediatrics. 1993 Aug;92(2):191–196. [PubMed] [Google Scholar]
  12. Kano S., Lanteri C. J., Pemberton P. J., Lesouef P. N., Sly P. D. Fast versus slow ventilation for neonates. Am Rev Respir Dis. 1993 Sep;148(3):578–584. doi: 10.1164/ajrccm/148.3.578. [DOI] [PubMed] [Google Scholar]
  13. Kelly E., Bryan H., Possmayer F., Frndova H., Bryan C. Compliance of the respiratory system in newborn infants pre- and postsurfactant replacement therapy. Pediatr Pulmonol. 1993 Apr;15(4):225–230. doi: 10.1002/ppul.1950150408. [DOI] [PubMed] [Google Scholar]
  14. Lesouef P. N., England S. J., Bryan A. C. Passive respiratory mechanics in newborns and children. Am Rev Respir Dis. 1984 Apr;129(4):552–556. [PubMed] [Google Scholar]
  15. Mammel M. C., Boros S. J., Bing D. R., Holloman K. K., Connett J. R. Determining optimum inspiratory time during intermittent positive pressure ventilation in surfactant-depleted cats. Pediatr Pulmonol. 1989;7(4):223–229. doi: 10.1002/ppul.1950070407. [DOI] [PubMed] [Google Scholar]
  16. Parker J. C., Hernandez L. A., Peevy K. J. Mechanisms of ventilator-induced lung injury. Crit Care Med. 1993 Jan;21(1):131–143. doi: 10.1097/00003246-199301000-00024. [DOI] [PubMed] [Google Scholar]
  17. Pfenninger J., Aebi C., Bachmann D., Wagner B. P. Lung mechanics and gas exchange in ventilated preterm infants during treatment of hyaline membrane disease with multiple doses of artificial surfactant (Exosurf) Pediatr Pulmonol. 1992 Sep;14(1):10–15. doi: 10.1002/ppul.1950140104. [DOI] [PubMed] [Google Scholar]
  18. Rosen W. C., Mammel M. C., Fisher J. B., Coleman J. M., Bing D. R., Holloman K. K., Boros S. J. The effects of bedside pulmonary mechanics testing during infant mechanical ventilation: a retrospective analysis. Pediatr Pulmonol. 1993 Sep;16(3):147–152. doi: 10.1002/ppul.1950160302. [DOI] [PubMed] [Google Scholar]
  19. Stenson B. J., Glover R. M., Wilkie R. A., Laing I. A., Tarnow-Mordi W. O. Life-threatening inadvertent positive end-expiratory pressure. Am J Perinatol. 1995 Sep;12(5):336–338. doi: 10.1055/s-2007-994490. [DOI] [PubMed] [Google Scholar]
  20. Stenson B. J., Wilkie R. A., Laing I. A., Tarnow-Mordi W. O. Reliability of clinical assessments of respiratory system compliance (Crs) made by junior doctors. Intensive Care Med. 1995 Mar;21(3):257–260. doi: 10.1007/BF01701484. [DOI] [PubMed] [Google Scholar]
  21. Stokes G. M., Milner A. D., Wilson A. J., Morgan D. B., Carman P. G., Oliver M. R. Ventilatory response to increased dead spaces in the first week of life. Pediatr Pulmonol. 1986 Mar-Apr;2(2):89–93. doi: 10.1002/ppul.1950020206. [DOI] [PubMed] [Google Scholar]
  22. Tarnow-Mordi W. O., Wilkie R. A., Reid E. Static respiratory compliance in the newborn. I: A clinical and prognostic index for mechanically ventilated infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jan;70(1):F11–F15. doi: 10.1136/fn.70.1.f11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wilkie R. A., Bryan M. H., Tarnow-Mordi W. O. Static respiratory compliance in the newborn. II: Its potential for improving the selection of infants for early surfactant treatment. Arch Dis Child Fetal Neonatal Ed. 1994 Jan;70(1):F16–F18. doi: 10.1136/fn.70.1.f16. [DOI] [PMC free article] [PubMed] [Google Scholar]

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