Research Information System
Thesis Type: Post Doctorate of Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2014
Student: SEZİN ÜNAL
Supervisor: NURİYE EBRU ERGENEKON
Abstract:Volume guarantee (VG) ventilation is frequently used for newborns, mostly combined with SIMV or A/C modes. Aim of this study was to compare effects of SIMV+VG or PSV+VG ventilation on ventilatory parameters, inflammtory biomarkers and clinical findings. Preterms with RDS < 37th gestational age (GA)requiring mechanical ventilation in the first 12 hours were randomized to either SIMV+VG or PSV+VG after surfactant treatment. Patients were ventilated with Draeger Babylog 8000+. Set and measured ventilatory parameters were downloaded by Babyview® software for 72 hours unless extubation or need for HFO ventilation occurred. Actual peak inspiratory pressure (PIP), set and measured tidal volume (TV), mean airway pressure (MAP) and FiO2 were analyzed. If measured TV percentage was between 80-120 % of set TV, it was considered appropriate. Tracheal aspirate specimens were collected twice; first at the sixth hour after surfactant treatment and second before extubation or HFO ventilation or 72nd hour of the randomized ventilation mode. IL-1β, IL-6, IL-8, IL-10 and TNF-α were analysed. Statistical analyses were performed with SPSS v15. Forty-two patients (21 PSV+VG, 21 SIMV+VG) were enrolled. Median GA were 29 weeks and BW were 980,0 and 870,0 gr in each group. Demographic characteristics were similar. "Appropriate TV" was higher PSV+VG group. TVs were more stable throughout treatment period breaths in PSV+VG group compared to SIMV+VG group. PIP, MAP and FiO2 were similar in two groups. IL-1β levels were found to be higher in second sampling time in both groups. The increase rate of IL-1β were similar in two groups. Significant increase in second sampling time in IL-8 levels were found only in PSV+VG group. IL-6, IL-10 and TNF-α levels were similiar both in between two groups and two sampled times within each group. Hypocarbia, hypercarbia, hyperoxemia and hypoxemia incidences were not different between groups. PSV+VG group was less tachycardic than SIMV+VG group. Acute and chronic prematurity problems including chronic lung disease (CLD) defined as oxygen requirement at 36th postmentrual age were not different. PSV+VG was associated with higher "appropriate TV" without any adverse effects and similar CLD occurence. These findings can support the beneficial use of PSV+VG which is more physiological due to better inspiratory expiratory synchrony.