The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

COMPARISON OF NEONATE TIDAL VOLUMES IN TIME CYCLED PRESSURE LIMITED OR VOLUME TARGETED VENTILATION DURING THE FIRST 48 HOURS OF LIFE.

John S. Emberger1, David Paul2, Michael Western1, Joel M. Brown1; 1Respiratory Care, Christiana Care Health System, Newark, DE; 2Pediatrics, Christiana Care Health System, Newark, DE

BACKGROUND: Conventional time cycled pressure limited ventilation as well as volume targeted ventilation has been used in our 60 Bed Level III NICU. Experts have proposed an optimal tidal volume range of 4 to 6 ml/kg for neonates, but there is limited published data for optimal tidal volume. Interest in volume targeted ventilation has increased in recent years. We wanted to compare the tidal volumes delivered to neonates in our NICU when receiving either time cycled pressure limited ventilation (TCPL) or volume targeted ventilation (VTV). METHODS: All neonates receiving mechanical ventilation June 2008 to June 2010 were retrospectively reviewed. Data included: ventilator mode, tidal volume, mean airway pressure (MAP), peak inspiratory pressure (PIP), birth weight and mortality. Tidal volume in ml/kg was calculated for tidal volumes in the first 48 hours of life using birth weight and converted to whole numbers for charting purposes. RESULTS: Four hundred seventy patients were identified as receiving TCPL during the first 48 hours of life with 4150 documented tidal volumes. Eighty patients were identified as receiving VTV ventilation during the first 48 hours of life with 598 documented tidal volumes. Neonates that were < 1500 grams birth weight comprised 52% of the TCPL group and 56% of the VTV group. See chart for tidal volume observations by ventilation mode. Tidal volumes were 4 to 6 ml/kg 51% of the time for the TCPL group and 79% of the time for the VTV group. Tidal volumes in ml/kg for TCPL and VTV were significantly different (p=0.018). There were 2.9 PIP adjustments per TCPL patient ordered and 1.6 tidal volume adjustments per VTV patient ordered. Mean MAP was 7.8±1.6 and 7.7±1.9 cmH2O for TCPL and VTV. Mean PIP was 17.4±3.2 and 16.6±6.6 cmH2O for TCPL and VTV. Mortality was 6.5% and 5.0% for TCPL and VTV(p=0.55). CONCLUSIONS: In our NICU: 1) TCPL ventilation was used six times more frequently than VTV ventilation in the first 48 hours of life. 2) Both TCPL and VTV ventilation were used in similar proportions on neonates < 1500 gram birth weight. 3) VTV ventilation was maintained at 4 to 6 ml/kg in a larger percent of observations (~80%) than TCPL ventilation (~50%). 4) Less ventilation adjustments were ordered in the VTV group. 5) MAP and PIP were similar for both groups. Larger, randomized, controlled studies are required to determine if the tidal volume control, offered by VTV, will yield positive long term outcomes in neonates. Sponsored Research - None Percent of Tidal Volume Observations By ml/kg Groups: TCPL Versus VTV Ventilation