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Am. J. Respir. Crit. Care Med., Volume 162, Number 3, September 2000, 826-831

Continuous Tracheal Gas Insufflation in Preterm Infants with Hyaline Membrane Disease
A Prospective Randomized Trial

GILLES DASSIEU, LAURENT BROCHARD, MOHAMED BENANI, SANDRINE AVENEL, and CLAUDE DANAN

Service de Réanimation Néonatale, Hôpital Intercommunal de Créteil, and Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France

In mechanically ventilated neonates, the instrumental dead space is a major determinant of total minute ventilation. By flushing this dead space, continuous tracheal gas insufflation (CTGI) may allow reduction of the risk of overinflation. We conducted a randomized trial to evaluate the efficacy of CTGI in reducing airway pressure over the entire period of mechanical ventilation while maintaining oxygenation. A total of 34 preterm newborns, ventilated in conventional pressure-limited mode, were enrolled in two study arms, to receive or not receive CTGI. Transcutaneous PaCO2 (tcPaCO2) was maintained at 40 to 46 mm Hg in both groups to ensure comparable alveolar ventilation. Respiratory data were collected several times during the first day and daily until Day 28. Both groups were similar at the time of inclusion. During the first 4 d of the study, the difference between peak pressure and positive end-expiratory pressure was significantly lower in the CTGI group by 18% to 35%, with the same tcPaCO2 level and with no difference in the ratio of tcPaO2 to fraction of inspired oxygen (245 ± 29 versus 261 ± 46 mm Hg [mean ± SD] over the first 4 d). Extubation occurred sooner in the CTGI group (p < 0.05), and the duration of mechanical ventilation was shorter (median: 3.6 d; 25th to 75th quartiles: 1.5 to 12.0 d; versus median: 15.6 d; 25th to 75th quartiles: 7.9 to 22.2; p < 0.05) than in the non-CTGI group. CTGI allows the use of low-volume ventilation over a prolonged period and reduces the duration of mechanical ventilation.




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