Volume-targeted versus pressure-limited ventilation in infants born at or near term

Prashanth Bhat; Olie Chowdhury; Sandeep Shetty; Simon Hannam; Gerrard F. Rafferty; Janet Peacock; Anne Greenough

doi:10.1007/s00431-015-2596-3

Volume-targeted versus pressure-limited ventilation in infants born at or near term

Prashanth Bhat, Olie Chowdhury, Sandeep Shetty, Simon Hannam, Gerrard F. Rafferty, Janet Peacock, Anne Greenough^*

^*Corresponding author for this work

MRC Medical Research Council

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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Abstract

Our aims were to determine whether volume-targeted ventilation (VTV) or pressure-limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoracoabdominal asynchrony (TAA) and associated with fewer hypocarbic episodes. Infants born at ≥34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age of 39 (range 34–42) weeks, were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5–312 h (VTV) versus 33.5, 1.312 h (PLV)) (p = 0.461). There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0–8) in the VTV group versus 4 (range 1–13) in the PLV group (p = 0.005).

Conclusion: In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation but was associated with significantly fewer hypocarbic episodes.

Original language	English
Pages (from-to)	89-95
Number of pages	7
Journal	European Journal of Pediatrics
Volume	176
Issue number	1
Early online date	4 Aug 2015
DOIs	https://doi.org/10.1007/s00431-015-2596-3
Publication status	Published - Jan 2016

Keywords

Extubation
Respiratory muscle strength
Thoracoabdominal asynchrony
Work of breathing

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Volume-targeted versus pressure_BHAT_Accepted8July2015_GREEN AAMAccepted author manuscript, 302 KB

Cite this

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title = "Volume-targeted versus pressure-limited ventilation in infants born at or near term",

abstract = "Our aims were to determine whether volume-targeted ventilation (VTV) or pressure-limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoracoabdominal asynchrony (TAA) and associated with fewer hypocarbic episodes. Infants born at ≥34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age of 39 (range 34–42) weeks, were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5–312 h (VTV) versus 33.5, 1.312 h (PLV)) (p = 0.461). There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0–8) in the VTV group versus 4 (range 1–13) in the PLV group (p = 0.005). Conclusion: In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation but was associated with significantly fewer hypocarbic episodes.",

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AU - Hannam, Simon

AU - Rafferty, Gerrard F.

AU - Peacock, Janet

AU - Greenough, Anne

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N2 - Our aims were to determine whether volume-targeted ventilation (VTV) or pressure-limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoracoabdominal asynchrony (TAA) and associated with fewer hypocarbic episodes. Infants born at ≥34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age of 39 (range 34–42) weeks, were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5–312 h (VTV) versus 33.5, 1.312 h (PLV)) (p = 0.461). There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0–8) in the VTV group versus 4 (range 1–13) in the PLV group (p = 0.005). Conclusion: In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation but was associated with significantly fewer hypocarbic episodes.

AB - Our aims were to determine whether volume-targeted ventilation (VTV) or pressure-limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoracoabdominal asynchrony (TAA) and associated with fewer hypocarbic episodes. Infants born at ≥34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age of 39 (range 34–42) weeks, were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5–312 h (VTV) versus 33.5, 1.312 h (PLV)) (p = 0.461). There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0–8) in the VTV group versus 4 (range 1–13) in the PLV group (p = 0.005). Conclusion: In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation but was associated with significantly fewer hypocarbic episodes.

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KW - Respiratory muscle strength

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Volume-targeted versus pressure-limited ventilation in infants born at or near term

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Keywords

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