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

Objective

To compare the efficacy and safety of volume-controlled (VC) ventilation to time-cycled pressure-limited (TCPL) ventilation in very low birth weight infants with respiratory distress syndrome (RDS).

Study design

Newborns weighing between 600 and 1500 g and with a gestational age of 24 to 31 weeks who had RDS were randomized to receive either VC or TCPL ventilation and treated with a standardized protocol. The 2 modalities were compared by determining the time required to achieve a predetermined success criterion, on the basis of either the alveolar-arterial oxygen gradient <100 mm Hg or the mean airway pressure <8 cm H₂O. Secondary outcomes included mortality, duration of mechanical ventilation, and complications commonly associated with ventilation.

Results

The mean time to reach the success criterion was 23 hours in the VC group versus 33 hours in the TCPL group (P = .15). This difference was more striking in babies weighing <1000g (21 versus 58 hours; P = .03). Mean duration of ventilation with VC was 255 hours versus 327 hours with TCPL (P = .60). There were 5 deaths in the VC group and 10 deaths in the TCPL group (P = .10). The incidence of other complications was similar.

Conclusion

VC ventilation is safe and efficacious in very low birth weight infants and may have advantages when compared with TCPL, especially in smaller infants.

Abbreviations:  AaDO₂, alveolar-arterial oxygen gradient , CPAP, continuous positive airway pressure , NICU, neonatal intensive care unit , RDS, respiratory distress syndrome , TCPL, time-cycled pressure-limited , VC, Volume-controlled