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Ventilated Infants Have Increased Dead Space and Lower Alveolar Tidal Volumes during the Early versus Recovery Phase of Respiratory Distress

Authors
  • Zuiki, Masashi
  • Yamano, Akio
  • Kitamura, Kazumasa
  • Goda, Takeshi
  • Oya, Satoshi
  • Komatsu, Hiroshi
Type
Published Article
Journal
Neonatology
Publisher
S. Karger AG
Publication Date
Dec 11, 2019
Volume
117
Issue
2
Pages
189–192
Identifiers
DOI: 10.1159/000504710
PMID: 31825947
Source
Karger
Keywords
License
Green
External links

Abstract

Background: Few studies have reported the measurement of anatomical dead space (V<sub>d,an</sub>) and alveolar tidal volume (V<sub>A</sub>) in ventilated neonates with respiratory distress. Objective: The aim of this study was to determine the differences in V<sub>d,an</sub> and V<sub>A</sub> in ventilated infants between the early and recovery phases of respiratory distress using volumetric ­capnography (V<sub>cap</sub>) based on ventilator graphics and capnograms. Methods: This study enrolled twenty-five ventilated infants (mean birth weight, 2,220 ± 635 g; mean gestational age, 34.7 ± 3.3 weeks). We adjusted respiratory settings to maintain appropriate oxygenation and tidal volume (V<sub>T</sub>), and performed V<sub>cap</sub> based on waveforms of ventilator graphics and capnograms. V<sub>d,an</sub> and V<sub>A</sub>were measured in infants with respiratory disorders, immediately after intubation (early phase) and subsequently when they were clinically stable (recovery phase). Results: The early phase, with lower dynamic lung compliance, required a higher level of ventilator support, not positive end-expiratory pressure, than the recovery phase. There were significant differences between the early and recovery phases for V<sub>d,an</sub> (mean difference in V<sub>d,an</sub>/kg = 0.57 mL/kg; 95% confidence interval [CI], 0.38–0.77; mean difference in V<sub>d,an</sub>/V<sub>T</sub> = 0.10; 95% CI, 0.07–0.14) and V<sub>A</sub> (mean difference in V<sub>A</sub>/kg = –0.60 mL/kg; 95% CI, –0.94 to –0.27; mean difference in V<sub>A</sub>/V<sub>T</sub> = –0.12; 95% CI, –0.15 to –0.09), despite no difference in V<sub>T</sub>. Conclusions: We evaluated changes in V<sub>d,an</sub> and V<sub>A</sub> during mechanical ventilation using V<sub>cap</sub> based on waveforms. The increase in V<sub>d,an</sub> and decrease in V<sub>A</sub> suggested dilation of the airways and collapse of the alveoli in ventilated infants with low lung compliance.

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