Treatment of neonates with respiratory distress syndrome by proportional assist ventilation plus synchronized intermittent mandatory ventilation: a comparison study.

BACKGROUND: The proportion assisted ventilation (PAV) can improve patient-ventilator interaction, reduce the incidence of end-expiratory asynchrony and increase the time of synchrony. PAV could compensate for the leaks by Elastic and resistive unloading and thus is ideal for neonates with uncuffed airways. The aim of this study was to compare the relevant clinical parameters of neonates with respiratory distress syndrome(RDS) who are surported by PAV plus synchronized intermittent mandatory ventilation (SIMV) and SIMV. METHODS: 46 neonates daignozed as RDS who required mechanical ventilation were divided randomly into observer group (surport by PAV + SIMV mode, n = 23) and control group (surport by SIMV mode, n = 23). The X-ray grading situation, the number of asynchrony- delayed trigger, the mean arterial blood pressure (MABP), spontaneous respiratory rate(RR), heart rate(HR), blood gas analysis values and circulation and respiratory parameters at each timepoint after 30min, 12h, 24h, 48h and 72h of mechanical ventilation were observed. RESULTS: The forty four neonates in two groups have been cured, the other 2 neonates (one in each group) gave up treatment and automatically discharged. There were no statistically significant differences in male, gestational age, body weight, The duration of mechanical ventilation, oxygen dependence and hospital stay between the two groups(all P>0.05). There were no statistically significant differences in MABP , HR and ratio of arterial-to-alveolar partial pressure of oxygen (a/APO2) at each time point after mechanical ventilation between the two groups(all P>0.05). The number of asynchrony- delayed trigger in observer group was lower than that in control group, the difference was statistically significant(P<0.05). The number of spontaneous RR in observer group was higher than that in control group, the difference was statistically significant(P<0.05). CONCLUSIONS: The PAV plus SIMV shows a good clinical effect in treatment of neonates with RDS. It could be better to use neonatal spontaneous breathing and might cause less damage to the lung than SIMV mode.