PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1323-1328
Feasibility of Tidal Volume-Guided Ventilation in Newborn Infants: A Randomized, Crossover Trial Using the Volume Guarantee Modality
Received May 9, 2000; accepted Sep 21, 2000.
From the * Department of Paediatrics, University of Cambridge;
and the Background and Aim. Volume guarantee
(VG) is a new composite mode of pressure-limited ventilation, available
on the Dräger Babylog 8000 ventilator, which allows the clinician
to set a target mean tidal volume to be delivered while still
maintaining control over peak airway pressures. This study aimed to
investigate the feasibility and efficacy of this mode of ventilation in
premature newborn infants with respiratory distress syndrome
(RDS).
Methods. Two groups of infants were studied: those
receiving synchronized intermittent positive pressure ventilation
(SIPPV) in early phase of RDS (group 1) and those in recovery phase of
RDS being weaned from artificial ventilation through synchronized
intermittent mandatory ventilation (SIMV; group 2). Both groups of
infants were studied over a 4-hour period. Before the start of the
study, the infants were either receiving SIPPV (group 1) or SIMV (group 2). Infants in group 1 were randomized to either continue on SIPPV for
the first hour of the study or to receive SIPPV plus VG for the first
hour. Subsequently, the 2 modes were used alternately for the remaining
three 1-hour periods. Similarly, infants in group 2 were randomized to
either continue on SIMV for the first hour of the study or to receive
SIMV plus VG for the first hour. Data on ventilation parameters and
transcutaneous carbon dioxide and oxygen were collected
continuously.
Results. Forty infants were studied, 20 in each group. The
mean (standard error) gestational age was 27.9 (0.3) weeks; birth
weight was 1064 (60) g. No adverse events were observed during the
study. Fractional inspired oxygen during SIMV plus VG was 0.31 (0.3); during
SIMV, 0.31 (0.3); during SIPPV plus VG, 0.41 (0.4); and during SIPPV,
0.40 (0.4). Transcutaneous carbon dioxide pressure during SIMV plus VG
was 6.0 (2.2) kPa; during SIMV, 5.9 (2.2) kPa; during SIPPV plus VG,
6.4 (2.9) kPa; and during SIPPV, 6.4 (2.8) kPa. Transcutaneous partial
pressure of oxygen during SIMV plus VG was 8.4 (8.7) kPa; during SIMV,
8.6 (8.8) kPa; during SIPPV plus VG, 7.6 (4.0) kPa; and during SIPPV,
7.7 (4.2) kPa. None of these differences was statistically significant. The mean (standard error) peak inspiratory pressure used during SIMV
was 17.1 (3.4) cm of water; during SIMV plus VG, 15.0 (7.5) cm of
water; during SIPPV plus VG, 17.1 (9.3) cm of water; and during SIPPV,
18.7 (8.3) cm of water. The mean airway pressure during SIMV plus VG
was 6.5 (3.1) cm of water; during SIMV, 6.9 (2.8) cm of water; during
SIPPV plus VG, 9.6 (4.5) cm of water; and during SIPPV, 9.8 (4.6) cm of
water.
Conclusion. VG seems to be a stable and feasible
ventilation mode for neonatal patients and can achieve equivalent gas
exchange using statistically significant lower peak airway pressures
both during early and recovery stages of RDS.ventilation, airway pressure, volume guarantee, tidal volume.
Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge,
United Kingdom.
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