Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome

Güven, Şirin; Bozdağ, Şenol; Saner, Hulya; Çetınkaya, Merih; Yazar, Ahmet Sami; Ergüven, Müferet

doi:10.3109/14767058.2012.733778

Cited by 19 publications

(23 citation statements)

References 28 publications

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“…Data reporting the length of mechanical ventilation in VTV and PLV groups are described in nine trials 19 21 24–26 29 31 33 35. The meta-analysis revealed a mathematical MD of −2.0 (−3.14 to −0.86) days reduced duration of ventilation using VTV (figure 5).…”

Section: Resultsmentioning

confidence: 99%

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Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis

Peng

Zhu

Shu

et al. 2013

Arch Dis Child Fetal Neonatal Ed

123

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Objective To assess the effect of volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) in preterm infants. Method We searched the Cochrane Library (Issue 3, 2013), PubMed (1966 to 5 March 2013, China National Knowledge Infrastructure (CNKI) and periodical databases (1979( to 5 March 2013. We selected randomised controlled trials (RCTs) and quasi-RCTs of VTV versus PLV as active interventions in preterm infants. We performed meta-analyses using the Cochrane statistical package RevMan 5.0. Results Eighteen trials met our inclusion criteria. There was no evidence that VTV modes reduced the incidence of death (relative risk (RR) 0.73, 95% CI 0.51 to 1.05). The use of VTV modes resulted in a reduction in the incidence of bronchopulmonary dysplasia (BPD) (RR 0.61, 95% CI 0.46 to 0.82) and duration of mechanical ventilation (mean difference (MD) −2.0 days, 95% CI −3.14 to −0.86). Conclusions Preterm infants ventilated using VTV modes had reduced duration of mechanical ventilation, incidence of BPD, failure of primary mode of ventilation, hypocarbia, grade 3/4 IVH, pneumothorax and PVL compared with preterm infants ventilated using PLV modes. There was no evidence that infants ventilated with VTV modes had reduced death compared to infants ventilated using PLV modes.

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Section: Resultsmentioning

confidence: 99%

“…Data reporting supplemental oxygen administration in VTV and PLV groups are described in two trials 21 27. The meta-analysis revealed a mathematical MD of −1.68 (−2.47 to −0.88) days reduced supplemental oxygen administration using VTV compared to PLV (table 2).…”

Section: Resultsmentioning

confidence: 99%

Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis

Peng

Zhu

Shu

et al. 2013

Arch Dis Child Fetal Neonatal Ed

123

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“…Herein, pneumothorax proved to be less likely in the VG group. A well-organized Cochrane review concluded lower mortality after receiving ventilation with VG (7), while Guven et al, found no significant decrease in death rate after volume-controlled ventilation (10). Nevertheless, no differences could be observed between the survival rates of the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Since safe level of oxygen saturation differs with postmenstrual age and stage of ROP, no fixed SpO 2 range is recommended so far (9). Lower SpO 2 level in early days of life could roughly have a preventive effect on ROP; though it increased death rates in several studies (10). Although avoidance of alteration between hypoxia and hyperoxia seems to be one of the desirable methods to decrease ROP, the benefits should be balanced against the risk of mortality and other morbidities such as cerebral palsy (11,12).…”

Section: Introductionmentioning

confidence: 99%

“…The effects of VG are recently studied with various aims including duration of ventilation, total need of oxygen supplementation, weaning from the ventilation (15), and neonatal morbidities and mortality (16); the latter one was more considerable. Guven et al, demonstrated lower incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and ROP in the subjects ventilated by VG mode compared to the ones received SIMV (10). However, to the best of authors' knowledge, no study so far investigated the incidence of ROP after VG ventilation specifically by controlling confounding factors.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Volume Guarantee Ventilation on the Incidence of Retinopathy of Prematurity

Mohagheghi

Gharib

Asadi³

2019

J Compr Ped

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Background: Newer technologies in neonatal ventilation such as combining volume guarantee with other modes of ventilation could reduce some complications of artificial ventilation by reducing the duration of ventilation and oxygen needs and fluctuations. Retinopathy of prematurity (ROP) is a multifactorial problem mainly affecting preterm infants with different risk factors. Although gestational age (GA) is the main risk factor for ROP, oxygen saturation and fluctuations, arterial pressure of carbon dioxide, and some other parameters of ventilation such as ventilation duration have great impacts on ROP incidence and severity. Methods: One hundred and twelve infants with birthweight (BW) under 2000 g or GA under 36 weeks that needed artificial ventilation after admission to the neonatal intensive care unit were randomly assigned into two groups. In the first group, neonates underwent synchronized intermittent mandatory ventilation (SIMV), pressure support ventilation (PSV), or SIMV + PSV with volume guarantee (VG); and in the second group, neonates received ventilation without VG mode. All of the survived infants had ophthalmologic examination at the proper age by a retinal subspecialist to find the different stages of ROP. Results: Mean duration of ventilation was reduced using VG mode from 74.08 ± 47.99 to 47.91 ± 30.47 hours (P < 0.05). The oxygen requirement was less in the ones underwent VG modes and the peak fractional inspired oxygen (FiO2) was higher in infants receiving SIMV + PSV without VG compared to that of infants ventilated with VG mode (52.8 ± 18.4 vs. 40.3 ± 13.0, respectively). The difference between highest and lowest FiO2 was more in the group ventilated without VG (∆FiO2 = 9.52 in the group I and 18.30 in the group II, P < 0.05). Fluctuation of arterial pressure of carbon dioxide (PaCO2) was less prominent in the VG group as compared to the ones ventilated without VG and the mean difference between maximum and minimum PaCO2 was 7.16 in the group I and 13.36 in the group II (P < 0.05). Only three infants were diagnosed with ROP in the group I (with VG mode) in comparison with eight infants in the group II (odds ratio (OR) = 3.25, 95% confidence interval (CI): 1.13-9.36). Severe ROP needing treatment was diagnosed in one infant in the group I vs. four infants in the group II (OR = 3, 95%CI: 0.63-14.23). Conclusions: ROP incidence in preterm infants could be reduced using VG mode of ventilation, since it is a safer ventilation mode in neonates due to reduction in the mean duration of ventilation, peak FiO2 requirement, and PaCO2 fluctuation.

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Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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ImportanceInterventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.ObjectiveTo evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.Data SourcesMEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.Study SelectionRandomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.Data Extraction and SynthesisTwo co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.Main Outcomes and MeasuresThe 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.ResultsA total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], −1% [95% CI, −2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, −5% [95% CI, −8% to −3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, −9% [95% CI, −13% to −5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, −3% [95% CI, −4% to −1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, −4% [95% CI, −7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, −30 [95% CI, −368 to −16]).Conclusions and RelevanceResults of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

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Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome

Cited by 19 publications

References 28 publications

Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis

Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis

The Effect of Volume Guarantee Ventilation on the Incidence of Retinopathy of Prematurity

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

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