Elsevier

The Journal of Pediatrics

Volume 157, Issue 5, November 2010, Pages 767-771.e3
The Journal of Pediatrics

Original Article
Ventilation Practices in the Neonatal Intensive Care Unit: A Cross-Sectional Study

https://doi.org/10.1016/j.jpeds.2010.05.043Get rights and content

Objective

To assess current ventilation practices in newborn infants.

Study design

We conducted a 2-point cross-sectional study in 173 European neonatal intensive care units, including 535 infants (mean gestational age 28 weeks and birth weight 1024 g). Patient characteristics, ventilator settings, and measurements were collected bedside from endotracheally ventilated infants.

Results

A total of 457 (85%) patients were conventionally ventilated. Time cycled pressure–limited ventilation was used in 59% of these patients, most often combined with synchronized intermittent mandatory ventilation (51%). Newer conventional ventilation modes like volume targeted and pressure support ventilation were used in, respectively, 9% and 7% of the patients. The mean tidal volume, measured in 84% of the conventionally ventilated patients, was 5.7 ± 2.3 ml/kg. The mean positive end-expiratory pressure was 4.5 ± 1.1 cmH2O and rarely exceeded 7 cmH2O.

Conclusions

Time cycled pressure–limited ventilation is the most commonly used mode in neonatal ventilation. Tidal volumes are usually targeted between 4 to 7 mL/kg and positive end-expiratory pressure between 4 to 6 cmH2O. Newer ventilation modes are only used in a minority of patients.

Section snippets

Methods

A prospective survey was conducted between April 2007 and May 2008 in 21 European countries, including 173 NICUs (Table I; available at www.jpeds.com). The study protocol was reviewed by the Institutional Review Board of each hospital. On two predefined dates, determined by one of the principle investigators (A.v.K.), patients in each NICU were included if they were on invasive mechanical ventilation at any time point between 9:00 am and 4:00 pm that day, and if the patients' corrected age at

Results

A total of 173 NICUs in 21 European countries participated in this study and included 535 patients (Table I). There were no patients studied on both dates. Most NICUs provided level 3 care, had more than 10 intensive care beds and ventilated on average more than 50 patients each year (Table II; available at www.jpeds.com). Most of the included infants were born prematurely, resulting in an overall median gestational age of 28 wks and a birth weight of 1024 g (Table III). At the time of data

Discussion

Since its introduction in the 1960s, mechanical ventilation has been one of the cornerstones in the treatment of respiratory failure in newborns. Over time, technological advances in ventilators have provided neonatologists with new ventilation modes and strategies, many of which have been tested in randomized controlled trials.5 However, the translation and implementation of these trial results to daily clinical practice has been poorly studied. In this survey we investigated how neonatal

References (17)

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Cited by (0)

The authors declare no conflicts of interest.

A list of Neovent Study Group members is available at www.jpeds.com (Appendix).

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