Comparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial

BACKGROUND: Pressure Support Ventilation (PSV) is one of the modes of mechanical ventilation that can be used alone as a weaning strategy in neonates. However, studies on the appropriate pressure level for this mode in neonates are limited.

OBJECTIVES: Because the use of adequate pressure support in this mode, keeping the appropriate neonate’s tidal volume, and preventing the respiratory complications, this study was aimed to compare extubation failure in the two levels of pressure support ventilation of 10 and 14 cmH2O when removing the neonates from the ventilator.

MATERIALS & METHODS: In this randomized clinical trial 50 premature infants of 27-37 weeks with respiratory distress syndrome (RDS) were under mechanical ventilation for at least 48 hours, were randomly assigned to two groups. One group was extubated in PSV mode with pressure of 14 cmH2O and the other with 10 cmH2O. Extubation failure rate and complications such as pneumothorax, death and respiratory parameters were compared in the two groups.

RESULTS: Twenty five neonates in each group were assessed. Weaning time, extubation failure rate, and mean airway pressure was lesser in PSV of 10 cmH20 group than Level of 14 cmH2O and those differences were statistically significant (P<0.05). Difference between work of breathing, ventilation time, pneumothorax and mortality rate between two groups were not statistically significant (P>0.05).

CONCLUSION: The results of our study show that extubation of the neonates using 10 CmH2O in PSV mode increases the success rate of extubation. Although when Volume- assured PSV can be used, it is more logical to use it for guaranteeing tidal volume, but using the appropriate level of pressure support when the PSV mode is used alone is inevitable and further studies are necessary to demonstrate the level of pressure in this mode.