507 Volume-Targeted Ventilation Reduces the Risk of Death or Bpd: A Cochrane Meta-Analysis

Abstract

Background and aims: Volutrauma is associated with neonatal lung injury. Modern ventilators offer volume-targeted modes aiming to reduce volutrauma and improve PaCO2 stability. The objectives were to determine whether volume-targeted ventilation (VTV), compared with pressure-limited ventilation (PLV), reduces mortality, bronchopulmonary dysplasia (BPD) and other outcomes. Methods: Cochrane systematic review of randomised clinical trials comparing VTV with PLV. Risk ratios (RR) or weighted mean difference with 95% confidence intervals (CI) were obtained from meta-analysis using a fixed effect model. Numbers needed to treat (NNT) were derived from risk differences. Results: Nine parallel trials (629 infants) and three crossover trials (64 infants) met inclusion criteria. There was no difference in hospital mortality {RR 0.80 (95% CI 0.53, 1.20)}. The use of VTV-modes resulted in a reduction in the combined outcome death or BPD {RR 0.73 (95% CI 0.57 to 0.93), NNT 8 (95% CI 5 to 33)}. VTV-modes also resulted in reductions in pneumothorax {RR 0.46 (95% CI 0.25 to 0.84), NNT 17 (95% CI 10 to 100)}, days of ventilation {MD -2.36 (95% CI -3.9 to -0.8)}, risk of hypocarbia {RR 0.56 (95% CI 0.33 to 0.96), NNT 4 (95% CI 2 to 25)} and the combined outcome PVL or grade 3-4 IVH {RR 0.48 (95% CI 0.28 to 0.84), NNT 11 (95% CI 7 to 50)}. Conclusions: Infants ventilated using VTV-modes had reduced death or BPD compared with infants ventilated using PLV-modes. Further research is needed to identify whether VTV-modes improve neurodevelopmental outcomes, and to determine best VTV practice.