Impact of volume guarantee on synchronized ventilation in preterm infants: a randomized controlled trial

The aim of this randomized controlled trial was to assess whether the addition of volume guarantee (VG) to triggered ventilation decreases the duration of ventilation in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS).

Infants were randomized into two groups to initially receive either assist/control (A/C) or A/C plus VG ventilation and then weaned with synchronized intermittent mandatory ventilation (SIMV) or SIMV plus VG.

Forty-five infants were included in the study. The demographic and clinical characteristics, values of tidal volume (VT), peak inspiratory pressure (PIP), fraction of inspired oxygen, carbon dioxide tension, and pH were similar for all participating infants initially. During the follow-up, the VT levels were more stable, and the PIP levels were significantly decreasing in the VG group. Although the duration of ventilation was shorter in the VG group, this trend was not statistically significant. The incidences of death and bronchopulmonary dysplasia (BPD) were not significantly different, but the combined outcome of death or BPD was lower in the VG group. Although the VG group experienced less frequent BPD, periventricular leukomalacia, and intraventricular hemorrhage, these differences were not statistically different.

The VG option, when combined with A/C (in the acute phase of RDS) and SIMV (in the weaning), reduced VT variability, and may have shortened the duration of ventilation in VLBW infants. Overall mortality and BPD rates did not change, but their combined outcome was significantly improved in infants treated with VG modes as compared to those treated with synchronized pressure-limited modes alone.