Elsevier

The Journal of Pediatrics

Volume 149, Issue 3, September 2006, Pages 308-313
The Journal of Pediatrics

Original article
Mechanical ventilation of very low birth weight infants: Is volume or pressure a better target variable?

Presented at the Annual Meeting of the Pediatric Academic Societies, Washington, DC, May 16, 2005.
https://doi.org/10.1016/j.jpeds.2006.01.044Get rights and content

Objective

To compare the efficacy and safety of volume-controlled (VC) ventilation to time-cycled pressure-limited (TCPL) ventilation in very low birth weight infants with respiratory distress syndrome (RDS).

Study design

Newborns weighing between 600 and 1500 g and with a gestational age of 24 to 31 weeks who had RDS were randomized to receive either VC or TCPL ventilation and treated with a standardized protocol. The 2 modalities were compared by determining the time required to achieve a predetermined success criterion, on the basis of either the alveolar-arterial oxygen gradient <100 mm Hg or the mean airway pressure <8 cm H2O. Secondary outcomes included mortality, duration of mechanical ventilation, and complications commonly associated with ventilation.

Results

The mean time to reach the success criterion was 23 hours in the VC group versus 33 hours in the TCPL group (P = .15). This difference was more striking in babies weighing <1000g (21 versus 58 hours; P = .03). Mean duration of ventilation with VC was 255 hours versus 327 hours with TCPL (P = .60). There were 5 deaths in the VC group and 10 deaths in the TCPL group (P = .10). The incidence of other complications was similar.

Conclusion

VC ventilation is safe and efficacious in very low birth weight infants and may have advantages when compared with TCPL, especially in smaller infants.

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

References (13)

There are more references available in the full text version of this article.

Cited by (92)

  • Novel Ventilation Strategies to Reduce Adverse Pulmonary Outcomes

    2022, Clinics in Perinatology
    Citation 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 Edition
  • Volume-Targeted Ventilation

    2021, Clinics in Perinatology
  • Automation of Respiratory Support

    2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition
  • Ventilator Strategies to Reduce Lung Injury and Duration of Mechanical Ventilation

    2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition
View all citing articles on Scopus
View full text