PATIENT-INITIATED, PRESSURE-REGULATED, VOLUME-CONTROLLED VENTILATION COMPARED WITH INTERMITTENT MANDATORY VENTILATION IN NEONATES - A PROSPECTIVE, RANDOMIZED STUDY

Objective: To compare the effects of patient-initiated, pressure-regul ated, volume-controlled ventilation (PRVC) with pressure-preset interm ittent mandatory ventilation (IMV) in neonates with respiratory failur e. Design: Randomised, prospective study. Setting: Intensive care unit (14 beds) in a 300-bed paediatric teaching hospital. Patients: 60 neo nates with respiratory distress syndrome (RDS) or congenital pneumonia , weighing < 2500 g and requiring mechanical ventilation. Intervention s: Ventilatory support until extubation via either IMV (n = 30) or PRV C (n = 27). In PRVC, the tidal volume (V-T) was preset and pressure-co ntrolled breaths delivered with peak inspiratory pressure values adapt ed to achieve the preset V-T. Measurements and results: Main outcome m easures were duration of ventilation and incidence of bronchopulmonary dysplasia (BPD). Pulmonary air leaks and intraventricular haemorrhage (IVH) were considered major adverse effects. Demographic data, ventil ation parameters and arterial/alveolar oxygen tension ratio were simil ar at randomisation. Duration of ventilation and incidence of BPD were not decreased by the use of PRVC. Air leaks occurred in 3 neonates in the PRVC group and in 7 babies treated with IMV (NS). The incidence o f IVH grade > II was lower in babies treated with PRVC (p < 0.05). In a subgroup of neonates weighing < 1000 g, the duration of ventilation and incidence of hypotension were reduced in the PRVC group (p < 0.05) . Conclusion: Patient-initiated, pressure-regulated, volume-controlled ventilation can be safely used in neonates and may contribute to a lo wer incidence of complications.