Original articleMechanical ventilation of very low birth weight infants: Is volume or pressure a better target variable?
Section snippets
Study Site
The study was conducted at the tertiary neonatal intensive care units (NICUs) at James Cook University Hospital and Hope Hospital between January 2002 and May 2004. The institutional review board approved the protocol, and written informed parental consent was obtained. However, recruitment was discontinued earlier at the second center because of a relatively high number of protocol violations. Nonetheless, all patients have been included in the main analysis on an intention-to-treat basis.
Inclusion Criteria
Results
During the study period, 221 eligible patients were admitted to the NICU and 110 were enrolled. The reasons for non-inclusion are shown in Figure 1. Analyses were performed on 57 infants assigned to VC ventilation and 52 infants assigned to TCPL ventilation.
There were no significant differences in the demographic characteristics of both groups at entry into the study, although a higher proportion of infants randomized to TCPL were outborn (Table I). The severity of respiratory illness at
Discussion
This was a pragmatic study designed to assess the efficacy and safety of VC ventilation in the management of respiratory failure in very low and extremely low birth weight babies. Although a truly masked study would have been preferable, the practicalities of blinding were felt to be too difficult to accomplish. Instead, a rigorous protocol was used. It was postulated that the study would provide general comparative information for traditional TCPL and VC ventilation, which has recently become
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2022, Clinics in PerinatologyCitation Excerpt :The major problem with pressure-controlled ventilation is that Vt changes with changes in lung compliance, which can occur rapidly and often results in lung overexpansion, volutrauma, and hypocapnia. Modern ventilators now make it possible to use volume-controlled ventilation in newborn infants by allowing for measurement of exhaled Vt at the airway opening, so that manual adjustment of set Vt at the ventilator end of the patient circuit is made to achieve a desired exhaled Vt.103 More convenient are volume-targeted modes that are modifications of pressure-controlled ventilation that automatically adjust inflation pressure to achieve a target Vt.104 With Vt as the primary control variable, peak inflation pressure is automatically reduced as lung compliance and patient inspiratory effort improve, resulting in real-time weaning, in contrast to intermittent manual lowering of peak inflation pressure in response to blood gas measurement. Volume guarantee (VG) is the most extensively studied form of VTV and the basic control algorithm is increasingly being adopted by other ventilator manufacturers.
Volume-targeted ventilation
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionVolume-Targeted Ventilation
2021, Clinics in PerinatologyAutomation of Respiratory Support
2018, The Newborn Lung: Neonatology Questions and Controversies, Third EditionVentilator Strategies to Reduce Lung Injury and Duration of Mechanical Ventilation
2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition