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European Journal of Pediatrics

, Volume 178, Issue 7, pp 1063–1068 | Cite as

Prediction of prolonged ventilator dependence in preterm infants

  • Kamal Ali
  • Sabena Kagalwalla
  • Iram Cockar
  • Emma E Williams
  • Kentaro Tamura
  • Theodore Dassios
  • Anne GreenoughEmail author
Original Article

Abstract

Volutrauma is an important factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Our aims were to identify risk factors in the first 24 h for prolonged ventilator dependence and assess volume delivery and carbon dioxide levels in infants with evolving BPD. A retrospective study was undertaken of 41 infants born at less than 32 weeks of gestational age (GA). A higher tidal volume, minute volume and resistance and a lower GA, birth weight and compliance were associated with a significantly higher risk of ventilator dependence at 28 days. The strongest relationships were with birth weight (area under the receiver operating characteristic curve, AUROC = 0.771) and GA (AUROC = 0.813). Tidal volume remained significantly higher after adjusting for GA in those who remained ventilator dependent at 28 days. The 18 who remained ventilator dependent at 28 days had increased mean carbon dioxide (PCO2) levels with increasing age from a mean of 41 mmHg in the first 24 h to 65 mmHg at 28 days PMA (p < 0.001). The increase in PCO2 occurred despite increases in peak inflation pressures (p < 0.001), tidal volumes (p = 0.002) and minute volumes (p < 0.001).

Conclusion: These results suggest that initial volutrauma may contribute to the development of chronic ventilator dependence.

What is Known:

In prematurely born infants, excessive tidal volumes are important in the pathogenesis of bronchopulmonary dysplasia (BPD), but a tidal volume that is too low will increase the risk of atelectasis, work of breathing and energy expenditure.

What is New:

A high tidal volume in the first 24 h was associated with an increased risk of ventilator dependence at 28 days, which remained significant after adjusting for gestational age. Carbon dioxide levels significantly increased over the first month despite increased pressures and volumes in those who remained ventilator dependent.

Keywords

Tidal volume Compliance Resistance Ventilator dependence Carbon dioxide levels Gestational age 

Abbreviations

ACV

assist control ventilation

BPD

bronchopulmonary dysplasia

CRS

compliance of the respiratory system

GA

gestational age

MV

minute volume

PIP

peak inflation pressure

PLV

pressure limited ventilation

SIMV

synchronised intermittent mandatory ventilation

VEGF

vascular endothelial growth factor

VT

tidal volume

Notes

Authors’ contributions

KA and AG designed the study. KA, SK and IC collected the data. KA, TD and AG analysed the data. All authors were involved in the preparation of the manuscript, critically reviewed the manuscript and approved the final manuscript as submitted.

Funding

The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Compliance and ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Routinely collected data were analysed, hence informed consent was not required.

Conflict of interest

AG has held grants from various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough has received honoraria for giving lectures and advising various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough is currently receiving a non conditional educational grant from SLE.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neonatal Intensive Care CentreKing’s College Hospital NHS Foundation TrustLondonUK
  2. 2.Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
  3. 3.Division of Neonatology, Maternal and Perinatal CentreToyama University HospitalToyamaJapan
  4. 4.MRC Centre for Allergic Mechanisms of AsthmaKing’s College LondonLondonUK
  5. 5.NIHR Biomedical Centre at Guy’s & St Thomas NHS Foundation TrustKing’s College LondonLondonUK

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