The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Volume Targeted Pressure Limited Ventilation Decreases Peak Airway Pressure and Mean Airway During Mechanical Ventilation in Neonates with ARDS

Brian K. Walsh, RRT-NPS, David Kaufman M.D.; University of Virginia Children’s Medical Center

Background: Current management of neonatal RDS has greatly reduced mortality and airleaks with the use of prenatal steroids and administration of surfactant. Once infants receive surfactant and as their endogenous surfactant pool increases, surface tension decreases and the lungs experience rapid changes in compliance. Conventionally, ventilator changes are made every few hours despite the fact that improvement of lung compliance often occurs minute to minute. Newer ventilation modality of volume targeted pressure limited ventilation (VTPL), designated Volume Guaranteed Ventilation (Dräger, Maheim, Germany), which targets a preset tidal volume at the lowest peak inspiratory pressure (PIP) required. This mode accommodates for compliance changes based on the previous breath’s expiratory tidal volume. This volume guarantee automatically regulates the inspiratory pressure allowing for the optimal pressure to be delivered to the lungs with each breath.

Methods: 13 intubated infants less than 30 weeks gestational age and less than 1000gm, 10 intubated infants more than 1000gm who were intubated with ARDS requiring surfactant treatment and infants less than 48 hours old who after admission to the NICU develop ARDS requiring surfactant therapy. Study subjects were randomized to either VTPL or PLV using the Babylog 8000 plus ventilators (Dräger) for 96 hours. Surfactant treatment and ventilation management guidelines were developed to ensure consistency among the 2 groups. Following this experimental period, infants were returned to what ever ventilation mode the primary team considered appropriate.

Results: Primary outcome measures at 96 hours demonstrated significantly lower (average) peak airway pressures with VTPL and lower (average) mean airway pressures than with PLV.

  VTPL PLV P value
n 11 12  
PIP (cmH2O) 15.49 20.92 0.007
MAP (cmH2O) 5.68 7.82 0.015
Weight (grams) 1171 1402 0.564
Gestational age (wks) 27.91 27.92 0.997
Ventilator Days 11.13 17.14 0.613
HFOV 2 7 0.048

While the size and prenatal risk factors were not different, duration of mechanical ventilation and the need for high frequency ventilation rescue were higher in the PLV group.

Conclusion: Volume targeted pressure limited ventilation reduces peak inspiratory pressure and mean airway pressure while achieving the same ventilation and oxygenation goals. Future multi-center studies need to be developed to determine if VTPL ventilation statistically reduces mortality, the need for HFOV, and ventilator days.


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