Feasibility of tidal volume-guided ventilation in newborn infants: A randomized, crossover trial using the volume guarantee modality

Background and Aim. Volume guarantee (VG) is a new composite mode of pressu re-limited ventilation, available on the Drager Babylog 8000 ventilator, wh ich allows the clinician to set a target mean tidal volume to be delivered while still maintaining control over peak airway pressures. This study aime d to investigate the feasibility and efficacy of this mode of ventilation i n premature newborn infants with respiratory distress syndrome (RDS). Methods. Two groups of infants were studied: those receiving synchronized i ntermittent positive pressure ventilation (SIPPV) in early phase of RDS (gr oup 1) and those in recovery phase of RDS being weaned from artificial vent ilation through synchronized intermittent mandatory ventilation (SIMV; grou p 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 SI MV (group 2). Infants in group 1 were randomized to either continue on SIPP V 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 th ree 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 V G for the first hour. Data on ventilation parameters and transcutaneous car bon dioxide and oxygen were collected continuously. Results. Forty infants were studied, 20 in each group. The mean (standard e rror) gestational age was 27.9 (0.3) weeks; birth weight was 1064 (60) g. N o 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 d uring SIPPV, 6.4 (2.8) kPa. Transcutaneous partial pressure of oxygen durin g 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 diff erences 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 S IPPV plus VG, 17.1 (9.3) cm of water; and during SIPPV, 18.7 (8.3) cm of wa ter. 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 neona tal patients and can achieve equivalent gas exchange using statistically si gnificant lower peak airway pressures both during early and recovery stages of RDS.