Mechanical ventilation of very low birth weight infants: Is volume or pressure a better target variable?

Singh, Jaideep; Sinha, Sunil K.; Clarke, Paul; Byrne, Steve; Donn, Steven M.

doi:10.1016/j.jpeds.2006.01.044

Cited by 81 publications

(43 citation statements)

References 14 publications

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“…[23][24][25] All are relatively small and addressed primarily physiological (mainly pneumothorax and duration of ventilation) and short-term outcomes. A recent meta-analysis of these trials indicates that there is a statistically significant reduction in pneumothorax and in the duration of ventilation, as well as a very strong trend toward decreased chronic lung disease (CLD) in babies treated with volume-targeted ventilation.…”

Section: Pressure Targeted Vs Volume Targetedmentioning

confidence: 99%

“…A recent meta-analysis of these trials indicates that there is a statistically significant reduction in pneumothorax and in the duration of ventilation, as well as a very strong trend toward decreased chronic lung disease (CLD) in babies treated with volume-targeted ventilation. The trial of Singh et al 25 also looked at longer-term follow-up and showed a medical correlate at 24 months' corrected age, with increased hospitalizations, wheezing and cough in infants treated with pressure-targeted ventilation compared with their volume-targeted counterparts. 26 Pressure support ventilation Trials examining the use of PSV in newborns have also been limited to physiological effects and short-term outcome measures, but the results are encouraging and suggest the need for future trials.…”

Section: Pressure Targeted Vs Volume Targetedmentioning

confidence: 99%

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Neonatal ventilators: how do they differ?

Donn

2009

J Perinatol

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Remarkable technological advances over the past two decades have brought dramatic changes to the neonatal intensive care unit. Microprocessor-based mechanical ventilation has replaced time-cycled, pressure-limited, intermittent mandatory ventilation with almost limitless options for the management of respiratory failure in the prematurely born infant. Unfortunately, much of the infusion of technology occurred before the establishment of a convincing evidence base. This review focuses on the basic principles of mechanical ventilation, nomenclature and the characteristics of both conventional and high-frequency devices.

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Section: Pressure Targeted Vs Volume Targetedmentioning

confidence: 99%

Section: Pressure Targeted Vs Volume Targetedmentioning

confidence: 99%

Neonatal ventilators: how do they differ?

Donn

2009

J Perinatol

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“…Volume-targeted ventilation has been shown to be effective in accelerating weaning in premature infants [12,22,26,27] . Although this faster weaning and shorter course of ventilation has not consistently improved long-term respiratory outcome, a meta-analysis showed improvements in the combined outcome of death or bronchopulmonary dysplasia (BPD) as indicated by a reduction in the relative risk of 0.73 (0.57 -0.93) compared with pressure-limited ventilation [31] .…”

Section: Automatic Adjustment Of Peak Pressure With Tidal Volume As Tmentioning

confidence: 99%

Role of automation in neonatal respiratory support

Claure

Bancalari²

2012

Journal of Perinatal Medicine

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Premature infants frequently present with respiratory instability, which is associated with fl uctuations in ventilation and gas exchange. Adjustment of respiratory support to the infant ' s needs is limited by staff availability and workload. Hence, automation is being explored as a way to improve the care of the premature infants. New modes of automatic respiratory support are being developed and becoming available for clinical use in preterm infants. These modes are expected to compensate for some of the limitations that presently exist in the conventional forms of respiratory support. Available evidence and preliminary fi ndings are promising, but further investigation is needed to determine the effects of these modalities on the long-term outcome of preterm infants.

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“…Most importantly, the variable leak around uncuffed ETTs used in newborn infants makes accurate control of delivered V T very difficult with traditional volume-controlled modes. A recent paper by Singh et al, 7 did demonstrate the feasibility of VCV when special measures are taken to compensate for these problems. In that study, the set V T was manually adjusted at frequent intervals to achieve a target exhaled V T measured by a proximal flow sensor at the airway opening.…”

Section: Traditional Volume-controlled Ventilationmentioning

confidence: 99%

State of the art in conventional mechanical ventilation

Keszler

2009

J Perinatol

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Despite a shift to noninvasive respiratory support, mechanical ventilation remains an essential tool in the care of critically ill neonates. The availability of a variety of technologically advanced devices with a host of available modes and confusing terminology presents a daunting challenge to the practicing neonatologist. Many of the available modes have not been adequately evaluated in newborn infants and there is paucity of information on the relative merits of those modes that have been studied. This review examines the special challenges of ventilating the extremely low birth weight infants that now constitute an increasing proportion of ventilated infants, attempts to provide a simple functional classification of ventilator modes and addresses the key aspects of synchronized ventilation modes. The rationale for volume-targeted ventilation is presented, the available modes are described and the importance of the open-lung strategy is emphasized. The available literature on volume-targeted modalities is reviewed in detail and general recommendations for their clinical application are provided. Volume guarantee has been studied most extensively and shown to reduce excessively large tidal volumes, decrease incidence of inadvertent hyperventilation, reduce duration of mechanical ventilation and reduce proinflammatory cytokines. It remains to be seen whether the demonstrated short-term benefits translate into significant reduction in chronic lung disease. Avoidance of mechanical ventilation by means of early continuous positive airway pressure with or without surfactant administration may still be the most effective way to reduce the risk of lung injury. For babies who do require mechanical ventilation, the combination of volume-targeted ventilation, combined with the open-lung strategy appears to offer the best chance of reducing the risk of bronchopulmonary dysplasia.

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Mechanical ventilation of very low birth weight infants: Is volume or pressure a better target variable?

Cited by 81 publications

References 14 publications

Neonatal ventilators: how do they differ?

Neonatal ventilators: how do they differ?

Role of automation in neonatal respiratory support

State of the art in conventional mechanical ventilation

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