Volume-targeted Ventilation Research Articles

Factors associated with initial tidal volume selection during neonatal volume-targeted ventilation in two NICUs: a retrospective cohort study.

ObjectiveTo quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to characterize the agreement of initial VT with the limited-evidence available.Study designWe performed a multi-center retrospective observational cohort study in two Neonatal Intensive Care Units evaluating 313 infants who received VTV as the initial ventilation modality prior to postnatal day 14. We generated descriptive statistics and performed multivariable logistic regression analysis to determine factors associated with initial VT use that agreed with available literature.Results154 (49%) infants received an initial VT of 5.0 mL/kg (median 5.0 mL/kg, IQR 5.0–5.1). 45 (14%) infants received an initial VT that was congruent with available literature. A birth weight of 700 –<1250 g was significantly associated with an initial VT in agreement with VT literature (aOR 9.4, 95% CI 1.7–50.4).ConclusionsMost infants receive an initial VT of 5.0 mL/kg.

Update on ventilatory management of extremely preterm infants-A Neonatal Intensive Care Unit perspective.

Extremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support. The approach of early intubation and surfactant administration through an endotracheal tube has been challenged in recent years by primary noninvasive respiratory support and newer methods of surfactant administration via thin catheters. Available data comparing the thin catheter method to endotracheal tube and delayed extubation in extremely preterm infants born before 28 weeks of gestation did not show differences in survival free of bronchopulmonary dysplasia. Data from numerous randomized trials comparing conventional ventilation with high‐frequency oscillatory ventilation did not show differences in meaningful outcomes. Among conventional modes of ventilation, there is good evidence to favor volume‐targeted ventilation over pressure‐limited ventilation. The former reduces the combined risk of bronchopulmonary dysplasia or death and several important secondary outcomes without an increase in adverse events. There are no evidence‐based guidelines to set positive end‐expiratory pressure in ventilated preterm infants. Recent research suggests that the forced oscillation technique may help to find the lowest positive end‐expiratory pressure at which lung recruitment is optimal. Benefits and risks of the various modes of noninvasive ventilation depend on the clinical setting, degree of prematurity, severity of lung disease, and competency of staff in treating associated complications. Respiratory care after discharge includes home oxygen therapy, lung function monitoring, weaning from medication started in the neonatal unit, and treatment of asthma‐like symptoms.

Successful management of dyspnea in a patient with stiff person syndrome with noninvasive positive-pressure ventilation: A case report

Approximately half of patients with stiff person syndrome experienced dyspnea due to the involvement of the respiratory muscles. If these muscles are severely affected, respiratory failure can occur. Here, we describe a patient with stiff person syndrome whose nighttime dyspnea was successfully controlled by noninvasive positive-pressure ventilation (NIPPV). A 38-year-old female patient visited the emergency room due to nighttime dyspnea. Her O2 saturation was 93%, and PaCO2 increased to 53.4 mmHg on arterial blood gas analysis. No specific lesion was found on the chest radiograph. We considered that her dyspnea was caused by respiratory muscle stiffness following SPS. For the management of nighttime hypercapnia, we applied NIPPV with volume-targeted assist-control ventilation mode using an oronasal mask interface during sleep. After such treatment, PaCO2 was normalized, and nighttime dyspnea disappeared. We think that NIPPV would be a useful therapeutic option for managing dyspnea induced by stiff person syndrome.

Implementing Volume-targeted Ventilation to Decrease Hypocarbia in Extremely Low Birth Weight Infants during the First Week of Life: A Quality Improvement Project.

Introduction:Hypocarbia in neonates increases the risk of poor neurodevelopmental outcomes. Volume-targeted ventilation (VTV) is associated with decreased hypocarbia and other respiratory morbidities. We noticed a high incidence of hypocarbia in extremely low birth weight (ELBW; <1,000 g) neonates in our Neonatal Intensive Care Unit. Thus, we undertook a quality improvement project to decrease the incidence of hypocarbia (the occurrence of PCO2 < 35 mm Hg) in ELBW neonates during the first week of life by 50% over 1 year.Methods:Our major interventions were employing VTV as the primary mode of mechanical ventilation in neonates less than 28 weeks of gestation or ELBW at birth and increasing staff knowledge regarding hypocarbia. The baseline period spanned May–August 2016. We implemented the interventions in October 2016 and tracked the use of VTV and the incidence of hypocarbia during the first week of life for 12 months.Results:We analyzed data on 28 and 77 patients in the baseline and postintervention periods, respectively. The use of VTV increased from 39% to 65%. However, the incidence of hypocarbia was not reduced (57% preintervention vs. 64% postintervention). In the postintervention cohort, the incidence of hypocarbia was comparable between VTV and other modes (60% vs. 70%; 95% confidence interval: −32%, 12%; P = 0.367), but we noted decreased blood gas sampling and earlier extubation in the VTV group (P = 0.002 and P = 0.046, respectively).Conclusions:Successfully increasing VTV in our Neonatal Intensive Care Unit did not decrease hypocarbia during the first week of life. However, we observed the safety of VTV and obtained other desirable results.

Increasing Volume-Targeted Ventilation Use in the NICU.

In preterm infants who require mechanical ventilation (MV), volume-targeted ventilation (VTV) modes are associated with lower rates of bronchopulmonary dysplasia compared with pressure-limited ventilation. Bronchopulmonary dysplasia rates in our NICU were higher than desired, prompting quality improvement initiatives to improve MV by increasing the use of VTV. We implemented and tested interventions over a 3-year period. Primary outcomes were the percentage of conventional MV hours when any-VTV mode was used and the percentage of conventional MV hours when an exclusively VTV mode was used. Exclusively VTV modes were modes in which all breaths were volume targeted. We evaluated outcomes during 3 project periods: baseline (May 2016-December 2016); epoch 1 (December 2016-October 2018), increasing the use of any-VTV mode; and epoch 2 (October 2018-November 2019), increasing the use of exclusively VTV modes. Use of any-VTV mode increased from 18 694 of 22 387 (83%) MV hours during baseline to 72 846 of 77 264 (94%) and 58 174 of 60 605 (96%) MV hours during epochs 1 and 2, respectively (P < .001). Use of exclusively VTV increased from 5967 of 22 387 (27%) during baseline to 47 364 of 77 264 (61%) and 46 091 of 60 605 (76%) of all conventional MV hours during epochs 1 and 2, respectively (P < .001). In statistical process control analyses, multiple interventions were associated with improvements in primary outcomes. Measured clinical outcomes were unchanged. Quality improvement interventions were associated with improved use of VTV but no change in measured clinical outcomes.

Congenital Diaphragmatic Hernia Management: A Systematic Review and Care Pathway Description Including Volume-Targeted Ventilation.

Although it is well established that standardized treatment protocols improve outcomes for infants with congenital diaphragmatic hernia (CDH), there remains variance between existing protocols. The purpose of this article was to review current literature on protocols for CDH management in the preoperative period and to describe a care pathway integrating best practice elements from existing literature with volume-targeted ventilation strategies previously in place at a major tertiary care center in the Pacific Northwestern United States. A systematic review of literature was performed according to PRISMA guidelines to identify current publications on CDH protocols and examine them for similarities and differences, particularly regarding ventilation strategies. Although existing protocols from multiple regions worldwide shared common goals of reducing barotrauma and delaying surgery until a period of clinical stabilization was achieved, their strategies varied. None included volume-targeted ventilation with pressure limitation as a method of avoiding ventilation-induced lung injury (VILI). Institutions that routinely manage infants with CDH should have a standardized treatment protocol in place, as this is shown to improve outcomes. This may include volume-targeted ventilation with pressure limitation as a successful VILI-limiting strategy. While standardized protocols have been shown to increase survival rate for infants with CDH, more research is needed to determine what these protocols should include. Specifically, there is a need for future study on the most appropriate ventilation mode for this population.

Early volume targeted ventilation in preterm infants born at 22-25 weeks of gestational age.

Early hypocapnia in preterm infants is associated with intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). Volume targeted ventilation (VTV) has been shown to reduce hypocapnia in preterm infants. Less is known of VTV in infants born at <26 weeks gestational age (GA). Our aim was to investigate the short- and long-term effects of early VTV as compared to pressure limited ventilation (PLV) in extremely preterm infants on the incidence of hypocapnia, days on ventilatory support, IVH, and BPD. A retrospective observational study of 104 infants born at 22-25 weeks GA (mean ± SD; 24+0 ± 1+1 GA; birth weight 619 ± 146 g), ventilated with either VTV (n = 44) or PLV (n = 60) on their first day of life. Ventilatory data and blood gases were collected at admission and every fourth hour during the first day of life, together with perinatal characteristics and outcomes. Peak inflation pressure (PIP) was lower in the VTV-group than in the PLV-group during the first 20 h of life (p < .05), without any difference in respiratory rate or FiO2 . Incidence of hypocapnia (PaCO2 < 4.5 kPa) was lower with VTV than PLV during the first day of life (32% vs. 62%; p < .01). Infants in the VTV-group were more frequently extubated at 24 h (30% vs. 13%; p < .05). IVH Grade ≥3, BPD, and time on mechanical ventilation did not differ between the groups. VTV is safe to apply in infants born at <26 GA and was observed to result in a lower incidence of hypocapnia compared to infants ventilated by PLV, without any differences in outcomes.

Physiological dead space and alveolar ventilation in ventilated infants

BackgroundDead space is the volume not taking part in gas exchange and, if increased, could affect alveolar ventilation if there is too low a delivered volume. We determined if there were differences in dead space and alveolar ventilation in ventilated infants with pulmonary disease or no respiratory morbidity.MethodsA prospective study of mechanically ventilated infants was undertaken. Expiratory tidal volume and carbon dioxide levels were measured. Volumetric capnograms were constructed to calculate the dead space using the modified Bohr–Enghoff equation. Alveolar ventilation (VA) was also calculated.ResultsEighty-one infants with a median (range) gestational age of 28.7 (22.4–41.9) weeks were recruited. The dead space [median (IQR)] was higher in 35 infants with respiratory distress syndrome (RDS) [5.7 (5.1–7.0) ml/kg] and in 26 infants with bronchopulmonary dysplasia (BPD) [6.4 (5.1–7.5) ml/kg] than in 20 term controls with no respiratory disease [3.5 (2.8–4.2) ml/kg, p < 0.001]. Minute ventilation was higher in both infants with RDS or BPD compared to the controls. VA in infants with RDS or BPD was similar to that of the controls [p = 0.54].ConclusionPrematurely born infants with pulmonary disease have a higher dead space than term controls, which may influence the optimum level during volume-targeted ventilation.ImpactMeasurement of the dead space was feasible in ventilated newborn infants.The physiological dead space was a significant proportion of the delivered volume in ventilated infants.The dead space (per kilogram) was higher in ventilated infants with respiratory distress syndrome or evolving bronchopulmonary dysplasia compared to term controls without respiratory disease.The dead space volume should be considered when calculating the most appropriate volume during volume-targeted ventilation.

Acute hemodynamic effects of non-invasive ventilation in patients with obesity hypoventilation syndrome.

To evaluate the acute effects of volume-targeted non-invasive ventilation (NIV) on hemodynamic parameters assessed by impedance cardiography in patients with obesity hypoventilation syndrome (OHS). Despite the well-described beneficial effects of NIV using volume-targeted pressure support ventilation modes on respiration in OHS patients, questions were raised about the impact of this treatment on the cardiovascular system. In 15 patients (10 men; mean age, 55.8±9.3 years) impedance cardiography recordings were taken at baseline, after 120 minutes while on NIV and 20 minutes after NIV termination. A repeated-measures analysis of variance was used for comparisons. Compared to baseline, a reduction in heart rate (from 80±11 to 73±10 beats per min, p<0.05) was observed on NIV whereas the stroke volume and cardiac index remained stable throughout all three assessed intervals (p=0.347, p=0.344; respectively). The pre-ejection period increased on NIV (from 113±16 to 127±20 ms, p<0.05), and the left ventricular ejection time increased after NIV termination compared to baseline (from 259±25 to 269±25 ms, p<0.05). Volume-targeted NIV may acutely improve systolic time intervals without any negative impact on the left ventricular function in OHS patients (Tab. 2, Ref. 17).

Cerebral oxygenation and circulatory parameters during pressure-controlled vs volume-targeted mechanical ventilation in extremely preterm infants.

Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant. To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO2 in extremely preterm infants. This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO2) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO2, and electrical cardiometry (EC) were used in monitoring of the patients. Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients' mean postnatal age was 7.7 days. The SpO2 values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO2, but based on a comparison of the standard deviations (SD) the StO2 variability was significantly lower during VG-AC. The circulatory parameters were comparable. The StO2 is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.

Accuracy of volume and pressure delivery by mechanical ventilators in use in neonatal intensive care units: A quality control study.

Despite technical specifications of neonatal mechanical ventilators (MVs) guarantee clinically irrelevant discrepancies between the set and the delivered values of ventilation parameters, previous studies reported large deviations. Most studies characterized performances of a given model/brand by studying a single device, disregarding possible intramodel differences, and leaving the accuracy of the ventilation parameters effectively delivered in clinical settings unknown. The aim of this study was to evaluate the real-life accuracy of pressure and volume parameters delivered by neonatal ventilators ready to be used on patients in neonatal intensive care units (NICUs). In vitro study. Neonatal ventilators (n = 33 of 8 different models) available in four European NICUs. The MVs were connected to a test lung (resistance = 50 cmH2 O*s/L, compliance = 0.35 mL/cmH2 O) provided with pressure and flow sensors. MVs were tested over two different ventilation modes randomly: (a) pressure controlled (PC) with a peak inspiratory pressure (PIP) of 22 cmH2 O, and (b) PC with volume targeted ventilation (VTV) with a tidal volume (VT ) of 6 mL. In all tests, positive end-expiratory pressure (PEEP) was set to 6 cmH2 O, respiratory rate to 45 breaths/min, inspiratory time to 0.33 seconds, and oxygen fraction to 0.3. During PC the median (min-max) values delivered were: PEEP = 5.84(4.95-6.48) cmH2 O, PIP = 21.63(20.04-22.62) cmH2 O. During VTV, VT was 5.94(4.63-8.01) mL. VT was considerably variable, ranging from -22% to +33% of the set and displayed values. Differences in accuracy among devices of the same model were comparable to those found among different models. Our findings suggest that loss of accuracy in ventilation variables is likely related to daily use of the devices rather than weakness in the design or manufacturing process, urging the improvement of maintenance and quality control procedures to preserve the performances of neonatal MVs during their entire lifespan.

2019 Year in Review: Neonatal Respiratory Support.

Respiratory support of the critically ill neonate has steadily shifted from invasive to noninvasive forms of support. There have recently been a number of important advances in our understanding of the changes to neonatal resuscitation practices as they pertain to clinically important outcomes, mechanisms of gas exchange for high-flow nasal cannula, and best use of noninvasive ventilation and predicting response. Although the proportion of infants requiring intubation and mechanical ventilation has decreased, the most severely ill often still require intubation and ventilation. Recently, volume-targeted ventilation, high-frequency ventilation, and different methods of assessing weaning and extubation have been investigated. This review summarizes a number of important advances that have been made in the management of prematurity and neonatal respiratory distress syndrome.

Volume-targeted versus pressure-limited ventilation for preterm infants

To compare the effects of volume-targeted ventilation (VTV) with pressure-limited ventilation (PLV) in preterm infants. A total of 100 preterm infants who required mechanical ventilation during the two study periods were investigated. PLV was used for 50 preterm infants during period 1 and VTV was used for 50 preterm infants during period 2. Clinical outcomes including mortality rate, duration of mechanical ventilation, air leak syndrome, hypocarbia, hypercarbia, hypoxemia, combined outcome of death or bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, and retinopathy of prematurity were evaluated. There was no significant difference (p > 0.05) in the duration of mechanical ventilation, air leak syndrome, hypocarbia, hypoxemia, or BPD between the two study groups. The mortality rate, hypercarbia, and combined outcome of death or BPD were significantly lower (p < 0.05) in the VTV group compared with the PLV group. Preterm infants using VTV had a lower mortality rate, less hypercarbia, and a significant decrease in the combined outcome of death or BPD.

Volume-targeted ventilation with a Fabian ventilator: maintenance of tidal volumes and blood CO2

ObjectiveTo analyse the performance of the Fabian +NCPAP evolution ventilator during volume guarantee (VG) ventilation in neonates at maintaining the target tidal volume and what tidal and minute volumes are...

Neonatal respiratory support strategies for the management of extremely low gestational age infants: an Italian survey

BackgroundWe aimed to survey Delivery Room and Neonatal Intensive Care Unit (NICU) respiratory strategies dedicated to the extremely low gestational age newborn (ELGAN – GA < 28 wks) in Italy.MethodsA questionnaire was sent to 113 Italian level III centres. A lead physician and a nurse with expertise in mechanical ventilation (MV) were identified in each unit to answer. Information about those aspects of ventilatory support considered by center’s staff as needing improvement was also collected.ResultsA 100% response rate was obtained. In the Delivery Room, sustained lung inflation was performed in 74.8% of centres, and 89.2% used NCPAP. For ELGANs who need invasive MV, conventional MV was the most used strategy. Volume-targeted ventilation and High-frequency oscillatory ventilation (HFOV) were considered as primary mode in < 30% of centres. Among non-invasive strategies, NCPAP was the most utilized, followed by BiPAP, High-flow nasal cannula and nasal intermittent positive pressure ventilation. Nurses more commonly recorded in the nursing charts the ventilator’s setting parameters rather than measured ones. HFOV and non-invasive ventilation were the most quoted aspects of neonatal ventilation felt as to be improved.ConclusionThe routine respiratory support practices in Italy showed marked variations among units. Focused interventions are largely required to improve clinical practice.

Survey of Ventilation Practices in the Neonatal Intensive Care Units of the United States and Canada: Use of Volume-Targeted Ventilation and Barriers to Its Use

To provide current data on ventilation practices and use of volume-targeted ventilation (VTV) in neonatal intensive care units of the United States and Canada, to identify the perceived barriers to the implementation of VTV, and to assess the knowledge base of appropriate initial tidal volume (VT ) settings for different hypothetical clinical scenarios. This was a cross-sectional online survey of individual neonatologists practicing in the United States and Canada. We received 387 responses (estimated response rate: ∼20%). Use of VTV was much higher in Canada (81%) compared with 39% in the United States. In the United States, VTV use is highest in the Northwest at 77% and lowest in the Northeast at 32.5%. The chief barrier to use of VTV was lack of knowledge about VTV and lack of appropriate equipment. The five clinical scenarios revealed that the majority of responders failed to select appropriate evidence-based VT for the specific scenario. Pressure-controlled ventilation remains the predominant approach to neonatal ventilation in the United States, while VTV is the preferred mode in Canada. Despite available data and important pathophysiological differences between patients, there is insufficient understanding of how to choose an appropriate VT in a variety of common clinical scenarios among users of VTV.

Anaesthetic management of robotic-assisted gynaecology surgery in the morbidly obese - A case series of 46 patients in a UK university teaching hospital.

Background and Aims:The evolution of robotic technology has enhanced the scope of laparoscopic surgery. Morbid obesity [body mass index (BMI) >40 kg/m2] due to significant physiological attributes presents a significant surgical and anaesthetic challenge. Robotic surgery in this subset of patients can present with its own problems due to surgical requirements of prolonged pneumoperitoneum and steep Trendelenburg position.Methods:We reviewed the anaesthetic management of 46 morbidly obese patients undergoing robotic-assisted laparoscopic gynaecology surgery. Patient characteristics, anaesthetic management, length of hospital stay (LOS), complications, and readmissions within 30 days were noted. Mean with standard deviation was used for statistical analysis.Results:The mean [standard deviation (SD)] weight and BMI were 121.2 (18.49) kg and 47.83 (7.89) kg/m2, respectively. The mean (SD) anaesthetic and surgical times were 229 (75.9) and 167.7 (62.7) min, respectively. The mean (SD) LOS was 1.57 (1.03) days. About 70% of patients were discharged on the first day after surgery. Six patients needed critical care support. There were two readmissions within 30 days.Conclusion:Good preparation, teamwork, and multidisciplinary input helped us to conduct complex robotic-assisted and long-duration surgery in morbidly obese patients with minimal complications.

Frequency, duration and cause of ventilator alarms on a neonatal intensive care unit

ObjectiveTo investigate the frequency and cause of neonatal ventilator alarms. Neonatal ventilators frequently alarm and also disturb babies, parents and nurses. If frequent they may cause alarm fatigue and be...

Volume-targeted versus pressure-limited ventilation in neonates.

Damage caused by lung overdistension (volutrauma) has been implicated in the development of bronchopulmonary dysplasia (BPD). Modern neonatal ventilation modes can target a set tidal volume as an alternative to traditional pressure-limited ventilation (PLV) using a fixed inflation pressure. Volume-targeted ventilation (VTV) aims to produce a more stable tidal volume in order to reduce lung damage and stabilise the partial pressure of carbon dioxide (pCO2). To determine whether VTV compared with PLV leads to reduced rates of death and death or BPD in newborn infants and to determine whether use of VTV affected outcomes including air leak, cranial ultrasound findings and neurodevelopment. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 12), MEDLINE via PubMed (1966 to 13 January 2017), Embase (1980 to 13 January 2017) and CINAHL (1982 to 13 January 2017). We also searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We contacted the principal investigators of studies to obtain supplementary information. Randomised and quasi-randomised trials comparing VTV versus PLV in infants of less than 44 weeks' postmenstrual age and reporting clinically relevant outcomes. We assessed risk of bias for each trial using Cochrane methodology. We evaluated quality of evidence for each outcome using GRADE criteria. We tabulated mortality, rates of BPD, short-term clinical outcomes and long-term developmental outcomes. for categorical outcomes, we calculated typical estimates for risk ratios (RR), risk differences (RD) and number needed to treat for an additional beneficial outcome (NNTB). For continuous variables, we calculated typical estimates for mean differences (MD). We used 95% confidence intervals (CI) and assumed a fixed-effect model for meta-analysis. Twenty randomised trials met our inclusion criteria; 16 parallel trials (977 infants) and four cross-over trials (88 infants). No studies were blinded and the quality of evidence for outcomes assessed varied from moderate to low.We found no difference in the primary outcome, death before hospital discharge, between VTV modes versus PLV modes (typical RR 0.75, 95% CI 0.53 to 1.07; low quality evidence). However, there was moderate quality evidence that the use of VTV modes resulted in a reduction in the primary outcome, death or BPD at 36 weeks' gestation (typical RR 0.73, 95% CI 0.59 to 0.89; typical NNTB 8, 95% CI 5 to 20) and the following secondary outcomes: rates of pneumothorax (typical RR 0.52, 95% CI 0.31 to 0.87; typical NNTB 20, 95% CI 11 to 100), mean days of mechanical ventilation (MD -1.35 days, 95% CI -1.83 to -0.86), rates of hypocarbia (typical RR 0.49, 95% CI 0.33 to 0.72; typical NNTB 3, 95% CI 2 to 5), rates of grade 3 or 4 intraventricular haemorrhage (typical RR 0.53, 95% CI 0.37 to 0.77; typical NNTB 11, 95% CI 7 to 25) and the combined outcome of periventricular leukomalacia with or without grade 3 or 4 intraventricular haemorrhage (typical RR 0.47, 95% CI 0.27 to 0.80; typical NNTB 11, 95% CI 7 to 33). VTV modes were not associated with any increased adverse outcomes. Infants ventilated using VTV modes had reduced rates of death or BPD, pneumothoraces, hypocarbia, severe cranial ultrasound pathologies and duration of ventilation compared with infants ventilated using PLV modes. Further studies are needed to identify whether VTV modes improve neurodevelopmental outcomes and to compare and refine VTV strategies.

Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants

ObjectivesVolume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine...