Published online March 2, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e679-e684 (doi:10.1542/peds.2008-2635)
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ARTICLE

Work of Breathing and Different Levels of Volume-Targeted Ventilation

Deena-Shefali Patel, MRCPCH, Atul Sharma, MBBS, Michael Prendergast, MRCPI, Gerrard F. Rafferty, PhD and Anne Greenough, MD

Division of Asthma, Allergy, and Lung Biology, King's College London School of Medicine, and Department of Child Health, King's College Hospital, London, England

OBJECTIVES. The objectives of this study were to determine the impact of different volume-targeted levels on the work of breathing and to investigate whether a level that reduced the work of breathing below that experienced during ventilatory support without volume targeting could be determined.

METHODS. The transdiaphragmatic pressure-time product, as an estimate of the work of breathing, was measured for 20 infants (median gestational age: 28 weeks) who were being weaned from respiratory support by using patient-triggered ventilation (either assist-control ventilation or synchronous intermittent mandatory ventilation). The transdiaphragmatic pressure-time product was measured first without volume targeting (baseline) and then at volume-targeted levels of 4, 5, and 6 mL/kg, delivered in random order. After each volume-targeted level, the infants were returned to baseline. Each step was maintained for 20 minutes.

RESULTS. The mean transdiaphragmatic pressure-time product was higher with volume targeting at 4 mL/kg in comparison with baseline, regardless of the patient-triggered mode. The transdiaphragmatic pressure-time product was higher at a volume-targeted level of 4 mL/kg in comparison with 5 mL/kg and at 5 mL/kg in comparison with 6 mL/kg. The mean work of breathing was below that at baseline only at a volume-targeted level of 6 mL/kg.

CONCLUSIONS. Low volume-targeted levels increase the work of breathing during volume-targeted ventilation. Our results suggest that, during weaning, a volume-targeted level of 6 mL/kg, rather than a lower level, could be used to avoid an increase in the work of breathing.

Key Words: prematurity • ventilation • volume

Abbreviations: ACV—assist-control ventilation • WOB—work of breathing • PTPdi—transdiaphragmatic pressure-time product • SIMV—synchronous intermittent mandatory ventilation • VTV—volume-targeted ventilation • VT—volume-targeted • VTE—expired tidal volume

Accepted Dec 15, 2008.


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