Volume Guarantee Ventilation during Surgical Closure of Patent Ductus Arteriosus

Martin Keszler; Kabir Abubakar

doi:10.1055/s-0034-1371713

American Journal of Perinatology, Table of Contents

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

¹Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island

,

Kabir Abubakar

²Department of Pediatrics, Georgetown University Hospital, Washington, District of Columbia

› Author Affiliations

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 (V_T) during retraction.

Objective The objective of this study was to describe ventilator support, V_T, 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 V_T 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 V_T was maintained with a modest increase in inflation pressure. Oxygenation remained adequate.

Conclusions VG avoided hypoxemia and maintained adequate V_T 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

Full Text

References

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
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
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
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
5 Abubakar KM, Keszler M. Patient-ventilator interactions in new modes of patient triggered ventilation. Pediatr Pulmonol 2001; 32 (1) 71-75
6 Keszler M, Abubakar K. Volume guarantee: stability of tidal volume and incidence of hypocarbia. Pediatr Pulmonol 2004; 38 (3) 240-245
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
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
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
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
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
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
13 Bhutani VK, Ritchie WG, Shaffer TH. Acquired tracheomegaly in very preterm neonates. Am J Dis Child 1986; 140 (5) 449-452
14 Tobias JD, Burd RS. Anaesthetic management and high frequency oscillatory ventilation. Paediatr Anaesth 2001; 11 (4) 483-487
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