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ARE FAST RATES AN EFFECTIVE ALTERNATIVE TO PARALYSIS?

We have previously demonstrated that infants who actively expire against positive pressure inflation at “conventional” ventilator rates develop pneumothoraces and amongst such infants pancuronium significantly reduces the incidence of air leaks (1) However pancuronium is not without side-effects, therefore this study investigated if fast rates could, as effectively, suppress spontaneous respiration and so possibly prevent pneumothoraces. 17 infants were demonstrated as actively expiring at ventilator rates of 30-40/minute by recording oesphageal pressure, tidal flow and volume simultaneously with ventilator pressure changes. The respiratory response of these infants to ventilator rates of 60 and 120/minute was then studied for 20 minute periods. The results are shown in the table.The 9 infants who remained actively expiring or had incoordinated respiration at fast rates were subsequently paralysed,only one developed a pneumothorax during ventilation.The 8 infants who breathed in synchrony or were apnoeic at fast rates were not paralysed and remained on increased rates, 4 later developed air leaks.We conclude that fast rate ventilation appears to have only limited success(18%)in suppressing respiratory activity in infants actively expiring against the ventilator. (1) Greenough et al Lancet 1984,i,1-4