Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2000 Jan;82(1):F5–F10. doi: 10.1136/fn.82.1.F5

International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome

J Baumer
PMCID: PMC1721044  PMID: 10634832

Abstract

AIM—To compare the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV) in preterm infants ventilated for respiratory distress syndrome (RDS).
METHODS—Nine hundred and twenty four babies from 22 neonatal intensive care units were assessed. They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome (RDS) for less than 6 hours within 72 hours of birth. The infants were randomly allocated to receive either PTV or IMV. Analysis was on an "intention to treat" basis. Death before discharge home or oxygen therapy at 36 weeks of gestation; pneumothorax while ventilated; cerebral ultrasound abnormality nearest to 6 weeks; and duration of ventilation in survivors were the main outcome measures.
RESULTS—There was no significant difference in outcome between the two groups. Unadjusted rates for death or oxygen dependency at 36 weeks of gestation were 47.4% and 48.7%, for PTV and IMV, respectively; for pneumothorax these were 13.4% and 10.3%; and for cerebral ultrasound abnormality nearest to 6 weeks these were 35.4% and 36.9%. Median duration of ventilation for survivors in both groups was 6 days. Overall, 79% of babies received only their assigned ventilation. PTV babies were more likely to depart from their intended ventilation (27% vs 15%). The trend towards higher pneumothorax rates with PTV occurred only in infants below 28 weeks of gestation (18.8% vs 11.8%).
CONCLUSIONS—There was no observed benefit from the use of PTV, with a trend towards a higher rate of pneumothorax under 28 weeks of gestation. Although PTV has a similar outcome to IMV for treatment of RDS in infants of 28 weeks or more gestation, within 72 hours of birth, it was abandoned more often. It cannot be recommended for infants of less than 28 weeks' gestation with the ventilators used in this study.



Full Text

The Full Text of this article is available as a PDF (133.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernstein G., Cleary J. P., Heldt G. P., Rosas J. F., Schellenberg L. D., Mannino F. L. Response time and reliability of three neonatal patient-triggered ventilators. Am Rev Respir Dis. 1993 Aug;148(2):358–364. doi: 10.1164/ajrccm/148.2.358. [DOI] [PubMed] [Google Scholar]
  2. Bernstein G., Heldt G. P., Mannino F. L. Body surface and airway triggered ventilation in extremely premature infants. Acta Paediatr. 1997 Nov;86(11):1275–1276. doi: 10.1111/j.1651-2227.1997.tb14864.x. [DOI] [PubMed] [Google Scholar]
  3. Bernstein G., Mannino F. L., Heldt G. P., Callahan J. D., Bull D. H., Sola A., Ariagno R. L., Hoffman G. L., Frantz I. D., 3rd, Troche B. I. Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. J Pediatr. 1996 Apr;128(4):453–463. doi: 10.1016/s0022-3476(96)70354-2. [DOI] [PubMed] [Google Scholar]
  4. Bignall S., Dixon P., Quinn C., Kitney R. Monitoring interactions between spontaneous respiration and mechanical inflations in preterm neonates. Crit Care Med. 1997 Mar;25(3):545–553. doi: 10.1097/00003246-199703000-00027. [DOI] [PubMed] [Google Scholar]
  5. Chan V., Greenough A. Randomised controlled trial of weaning by patient triggered ventilation or conventional ventilation. Eur J Pediatr. 1993 Jan;152(1):51–54. doi: 10.1007/BF02072516. [DOI] [PubMed] [Google Scholar]
  6. Charon A., Taeusch W., Fitzgibbon C., Smith G. B., Treves S. T., Phelps D. S. Factors associated with surfactant treatment response in infants with severe respiratory distress syndrome. Pediatrics. 1989 Mar;83(3):348–354. [PubMed] [Google Scholar]
  7. Dimitriou G., Greenough A., Laubscher B., Yamaguchi N. Comparison of airway pressure-triggered and airflow-triggered ventilation in very immature infants. Acta Paediatr. 1998 Dec;87(12):1256–1260. doi: 10.1080/080352598750030942. [DOI] [PubMed] [Google Scholar]
  8. Donn S. M., Nicks J. J., Becker M. A. Flow-synchronized ventilation of preterm infants with respiratory distress syndrome. J Perinatol. 1994 Mar-Apr;14(2):90–94. [PubMed] [Google Scholar]
  9. Donn S. M., Sinha S. K. Controversies in patient-triggered ventilation. Clin Perinatol. 1998 Mar;25(1):49–61. [PubMed] [Google Scholar]
  10. Field D., Milner A. D., Hopkin I. E. Inspiratory time and tidal volume during intermittent positive pressure ventilation. Arch Dis Child. 1985 Mar;60(3):259–261. doi: 10.1136/adc.60.3.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Field D., Milner A. D., Hopkin I. E. Manipulation of ventilator settings to prevent active expiration against positive pressure inflation. Arch Dis Child. 1985 Nov;60(11):1036–1040. doi: 10.1136/adc.60.11.1036. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gitlin J. D., Soll R. F., Parad R. B., Horbar J. D., Feldman H. A., Lucey J. F., Taeusch H. W. Randomized controlled trial of exogenous surfactant for the treatment of hyaline membrane disease. Pediatrics. 1987 Jan;79(1):31–37. [PubMed] [Google Scholar]
  13. Greenough A., Greenall F. Observation of spontaneous respiratory interaction with artificial ventilation. Arch Dis Child. 1988 Feb;63(2):168–171. doi: 10.1136/adc.63.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Greenough A., Hird M. F., Chan V. Airway pressure triggered ventilation for preterm neonates. J Perinat Med. 1991;19(6):471–476. doi: 10.1515/jpme.1991.19.6.471. [DOI] [PubMed] [Google Scholar]
  15. Greenough A., Morley C. J., Pool J. Fighting the ventilator--are fast rates an effective alternative to paralysis? Early Hum Dev. 1986 Apr;13(2):189–194. doi: 10.1016/0378-3782(86)90007-1. [DOI] [PubMed] [Google Scholar]
  16. Greenough A., Wood S., Morley C. J., Davis J. A. Pancuronium prevents pneumothoraces in ventilated premature babies who actively expire against positive pressure inflation. Lancet. 1984 Jan 7;1(8367):1–3. doi: 10.1016/s0140-6736(84)90177-6. [DOI] [PubMed] [Google Scholar]
  17. Hallman M., Merritt T. A., Jarvenpaa A. L., Boynton B., Mannino F., Gluck L., Moore T., Edwards D. Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. J Pediatr. 1985 Jun;106(6):963–969. doi: 10.1016/s0022-3476(85)80253-5. [DOI] [PubMed] [Google Scholar]
  18. Hird M. F., Greenough A. Comparison of triggering systems for neonatal patient triggered ventilation. Arch Dis Child. 1991 Apr;66(4 Spec No):426–428. doi: 10.1136/adc.66.4_spec_no.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Horbar J. D., Soll R. F., Sutherland J. M., Kotagal U., Philip A. G., Kessler D. L., Little G. A., Edwards W. H., Vidyasagar D., Raju T. N. A multicenter randomized, placebo-controlled trial of surfactant therapy for respiratory distress syndrome. N Engl J Med. 1989 Apr 13;320(15):959–965. doi: 10.1056/NEJM198904133201502. [DOI] [PubMed] [Google Scholar]
  20. Hummler H., Gerhardt T., Gonzalez A., Claure N., Everett R., Bancalari E. Influence of different methods of synchronized mechanical ventilation on ventilation, gas exchange, patient effort, and blood pressure fluctuations in premature neonates. Pediatr Pulmonol. 1996 Nov;22(5):305–313. doi: 10.1002/(SICI)1099-0496(199611)22:5<305::AID-PPUL3>3.0.CO;2-J. [DOI] [PubMed] [Google Scholar]
  21. Jarreau P. H., Moriette G., Mussat P., Mariette C., Mohanna A., Harf A., Lorino H. Patient-triggered ventilation decreases the work of breathing in neonates. Am J Respir Crit Care Med. 1996 Mar;153(3):1176–1181. doi: 10.1164/ajrccm.153.3.8630564. [DOI] [PubMed] [Google Scholar]
  22. Konishi M., Fujiwara T., Naito T., Takeuchi Y., Ogawa Y., Inukai K., Fujimura M., Nakamura H., Hashimoto T. Surfactant replacement therapy in neonatal respiratory distress syndrome. A multi-centre, randomized clinical trial: comparison of high- versus low-dose of surfactant TA. Eur J Pediatr. 1988 Jan;147(1):20–25. doi: 10.1007/BF00442605. [DOI] [PubMed] [Google Scholar]
  23. Laubscher B., Greenough A., Kavadia V. Comparison of body surface and airway triggered ventilation in extremely premature infants. Acta Paediatr. 1997 Jan;86(1):102–104. doi: 10.1111/j.1651-2227.1997.tb08841.x. [DOI] [PubMed] [Google Scholar]
  24. Levene M. I. Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound. Arch Dis Child. 1981 Dec;56(12):900–904. doi: 10.1136/adc.56.12.900. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Long W., Corbet A., Cotton R., Courtney S., McGuiness G., Walter D., Watts J., Smyth J., Bard H., Chernick V. A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group. N Engl J Med. 1991 Dec 12;325(24):1696–1703. doi: 10.1056/NEJM199112123252404. [DOI] [PubMed] [Google Scholar]
  26. McCord F. B., Curstedt T., Halliday H. L., McClure G., Reid M. M., Robertson B. Surfactant treatment and incidence of intraventricular haemorrhage in severe respiratory distress syndrome. Arch Dis Child. 1988 Jan;63(1):10–16. doi: 10.1136/adc.63.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mehta A., Wright B. M., Callan K., Stacey T. E. Patient-triggered ventilation in the newborn. Lancet. 1986 Jul 5;2(8497):17–19. doi: 10.1016/s0140-6736(86)92562-6. [DOI] [PubMed] [Google Scholar]
  28. Milner A. D., Hoskyns E. W. High frequency positive pressure ventilation in neonates. Arch Dis Child. 1989 Jan;64(1 Spec No):1–3. doi: 10.1136/adc.64.1_spec_no.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Morley C. J. Surfactant substitution in the newborn by application of artificial surfactant. J Perinat Med. 1987;15(5):469–478. doi: 10.1515/jpme.1987.15.5.469. [DOI] [PubMed] [Google Scholar]
  30. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design. Br J Cancer. 1976 Dec;34(6):585–612. doi: 10.1038/bjc.1976.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Quinn M. W., de Boer R. C., Ansari N., Baumer J. H. Stress response and mode of ventilation in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F195–F198. doi: 10.1136/fn.78.3.f195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. South M., Morley C. J. Synchronous mechanical ventilation of the neonate. Arch Dis Child. 1986 Dec;61(12):1190–1195. doi: 10.1136/adc.61.12.1190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Upton C. J., Milner A. D., Stokes G. M. The effect of changes in inspiratory time on neonatal triggered ventilation. Eur J Pediatr. 1990 Jun;149(9):648–650. doi: 10.1007/BF02034755. [DOI] [PubMed] [Google Scholar]
  34. Visveshwara N., Freeman B., Peck M., Caliwag W., Shook S., Rajani K. B. Patient-triggered synchronized assisted ventilation of newborns. Report of a preliminary study and three years' experience. J Perinatol. 1991 Dec;11(4):347–354. [PubMed] [Google Scholar]
  35. de Boer R. C., Jones A., Ward P. S., Baumer J. H. Long term trigger ventilation in neonatal respiratory distress syndrome. Arch Dis Child. 1993 Mar;68(3 Spec No):308–311. doi: 10.1136/adc.68.3_spec_no.308. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Acknowledgement]
archdischfn_82_1_F5__index.html (3KB, html)

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES