Continuous tracheal gas insufflation in preterm infants with hyaline membrane disease - A prospective randomized trial

In mechanically ventilated neonates, the instrumental dead space is a major determinant of total minute ventilation. By flushing this dead space, cont inuous tracheal gas insufflation (CTGI) may allow reduction of the risk of overinflation. We conducted a randomized trial to evaluate the efficacy of CTGI in reducing airway pressure over the entire period of mechanical venti lation while maintaining oxygenation, a total of 34 preterm newborns, venti lated in conventional pressure-limited mode, were enrolled in two study arm s, to receive or not receive CTGI. Transcutaneous Pa-CO2 (tcPa(CO2)) was ma intained at 40 to 46 mm Hg in both groups to ensure comparable alveolar ven tilation. Respiratory data were collected several times during the first da y and daily until Day 28. Both groups were similar at the time of inclusion . During the first 4 d of the study, the difference between peak pressure a nd positive end-expiratory pressure was significantly lower in the CTGI gro up by 18% to 35%, with the same tcPa(CO2) level and with no difference in t he ratio of tcPa(O2) to fraction of inspired oxygen (245 +/- 29 versus 261 +/- 46 mm Hg [mean +/- SD] over the first 4 d). Extubation occurred sooner in the CTGI group (p < 0.05), and the duration of mechanical ventilation wa s shorter (median: 3.6 d; 25th to 75th quartiles: 1.5 to 12.0 d; versus med ian: 15.6 d; 25th to 75th quartiles: 7.9 to 22.2; p < 0.05) than in the non -CTGI group. CTGI allows the use of low-volume ventilation over a prolonged period and reduces the duration of mechanical ventilation.