Volume guarantee ventilation in neonates treated with hypothermia for hypoxic-ischemic encephalopathy during interhospital transport.

Abstract

ObjectiveWe investigated if volume guarantee (VG) ventilation in babies with hypoxic-ischemic encephalopathy (HIE) during interhospital transport decreases tidal volumes and prevents hypocapnia.Study designWe computationally collected and analyzed ventilator data of babies ventilated with synchronized intermittent mandatory ventilation (SIMV) with VG (n = 28) or without VG (n = 8).ResultThe expiratory tidal volume of ventilator inflations was lower with SIMV-VG (median [IQR]: 4.9 [4.6–5.3] mL/kg) than with SIMV only (median [IQR]: 7.1 [5.3–8.0] mL/kg, p = 0.01). Babies receiving SIMV-VG had lower peak inflating pressures (median: 10.7 cmH2O, versus 17.5 cmH2O, p = 0.01). There was no significant difference in minute ventilation or in pCO2. Babies with strong spontaneous breathing had a mean PIP < 10 cmH2O but this did not result in adverse events or worsening of acidosis.ConclusionsThe use of VG ventilation in babies with HIE reduces tidal volumes and frequently results in very low inflating pressures without affecting pCO2.