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Am J Perinatol 2015; 32(01): 023-026
DOI: 10.1055/s-0034-1371713
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Volume Guarantee Ventilation during Surgical Closure of Patent Ductus Arteriosus

Martin Keszler
1   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island
,
Kabir Abubakar
2   Department of Pediatrics, Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
Further Information

Publication History

29 January 2014

30 January 2014

Publication Date:
04 April 2014 (online)

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Abstract

Background Surgical closure of patent ductus arteriosus (PDA) is associated with adverse outcomes. Surgical exposure requires retraction of the lung, resulting in decreased aeration and compliance. Optimal respiratory support for PDA surgery is unknown. Experience with volume guarantee (VG) ventilation at our institution led us to hypothesize that surgery would be better tolerated with automatic adjustment of pressure by VG to maintain tidal volume (VT) during retraction.

Objective The objective of this study was to describe ventilator support, VT, and oxygenation of infants supported with VG during PDA surgery.

Design/Methods Ventilator variables, oxygen saturation, and heart rate were recorded during PDA surgery in a convenience sample of infants during PDA closure on VG. Pressure limit increased 11% and set VT was 26% lower during lung retraction. Fentanyl and pancuronium/vecuronium were used for anesthesia/muscle relaxation. Longitudinal data were analyzed by analysis of variance for repeated measures.

Results Seven infants, 25.4 ± 1.5 weeks and 723 ± 141 g, underwent closure of PDA on VG at a mean age 29.9 days. No air leak, bradycardia, or death occurred. Target VT was maintained with a modest increase in inflation pressure. Oxygenation remained adequate.

Conclusions VG avoided hypoxemia and maintained adequate VT with only a modest increase in peak inflation pressure and thus may be a useful mode during PDA surgery.

Keywords

patent ductus arteriosus - surgical closure - volume guarantee ventilation

Note

Dr. Keszler has been a consultant to Draeger Medical, Inc. No person from the company had any input into any aspect of the work. No financial or other support was received.


 

  • References

  • 1 Laughon M, Bose C, Clark R. Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol 2007; 27 (3) 164-170
    CrossrefPubMedGoogle Scholar
  • 2 Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150 (3) 229-234, 234. e1
    CrossrefPubMedGoogle Scholar
  • 3 Chorne N, Leonard C, Piecuch R, Clyman RI. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics 2007; 119 (6) 1165-1174
    CrossrefPubMedGoogle Scholar
  • 4 Clyman R, Cassady G, Kirklin JK, Collins M, Philips 3rd JB. The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial. J Pediatr 2009; 154 (6) 873-876
    CrossrefPubMedGoogle Scholar
  • 5 Abubakar KM, Keszler M. Patient-ventilator interactions in new modes of patient triggered ventilation. Pediatr Pulmonol 2001; 32 (1) 71-75
    CrossrefPubMedGoogle Scholar
  • 6 Keszler M, Abubakar K. Volume guarantee: stability of tidal volume and incidence of hypocarbia. Pediatr Pulmonol 2004; 38 (3) 240-245
    CrossrefPubMedGoogle Scholar
  • 7 Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database Syst Rev 2010; (11) CD003666
    PubMedGoogle Scholar
  • 8 Shenassa H, Sankaran K, Duncan W, Tyrrell M, Bharadwaj B. Surgical ligation of patent ductus arteriosus in a neonatal intensive care unit is safe and cost effective. Can J Cardiol 1986; 2 (6) 353-355
    PubMedGoogle Scholar
  • 9 Taylor RL, Grover FL, Harmon PK, Escobedo MK, Ramamurthy RS, Trinkle JK. Operative closure of patent ductus arteriosus in premature infants in the neonatal intensive care unit. Am J Surg 1986; 152 (6) 704-708
    CrossrefPubMedGoogle Scholar
  • 10 Gould DS, Montenegro LM, Gaynor JW , et al. A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics 2003; 112 (6 Pt 1) 1298-1301
    CrossrefPubMedGoogle Scholar
  • 11 Keszler M, Abubakar KM. Volume guarantee ventilation. In: Donn SM, Wiswell T, , eds. Clinics in Perinatology: Update on Surfactant and Mechanical Ventilation. Vol. 34. Philadelphia, PA: Elsevier Press; 2007: 107-116
    Google Scholar
  • 12 Keszler M, Nassabeh-Montazami S, Abubakar K. Evolution of tidal volume requirement during the first three weeks of life in infants <800 g ventilated with volume-guarantee. Arch Dis Child Fetal Neonatal Ed 2009; 94 (4) F279-F282
    CrossrefPubMedGoogle Scholar
  • 13 Bhutani VK, Ritchie WG, Shaffer TH. Acquired tracheomegaly in very preterm neonates. Am J Dis Child 1986; 140 (5) 449-452
    PubMedGoogle Scholar
  • 14 Tobias JD, Burd RS. Anaesthetic management and high frequency oscillatory ventilation. Paediatr Anaesth 2001; 11 (4) 483-487
    CrossrefPubMedGoogle Scholar
  • 15 Muralidhar K, Shetty DP. Ventilation strategy for video-assisted thoracoscopic clipping of patent ductus arteriosus in children. Paediatr Anaesth 2001; 11 (1) 45-48
    CrossrefPubMedGoogle Scholar