Volume-targeted versus pressure-limited ventilation in neonates

Area of Science:

• Neonatal respiratory support
• Mechanical ventilation strategies
• Pulmonary medicine

Background:

• Lung overdistension (volutrauma) is linked to bronchopulmonary dysplasia (BPD) in neonates.
• Volume-targeted ventilation (VTV) offers a stable tidal volume alternative to pressure-limited ventilation (PLV).
• VTV aims to minimize lung damage and stabilize partial pressure of carbon dioxide (pCO2).

Purpose of the Study:

• To compare VTV with PLV for rates of death and death or BPD in newborns.
• To assess VTV's impact on air leak, cranial ultrasound findings, and neurodevelopmental outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched Cochrane Neonatal, MEDLINE, Embase, and CINAHL databases.
• Included infants <44 weeks' postmenstrual age with clinically relevant outcomes.

Main Results:

• No significant difference in death before hospital discharge between VTV and PLV (low quality evidence).
• VTV significantly reduced death or BPD, pneumothorax, hypocarbia, and severe intraventricular hemorrhage (moderate quality evidence).
• VTV decreased mechanical ventilation duration without increased adverse outcomes.

Conclusions:

• VTV reduces combined death or BPD, pneumothoraces, hypocarbia, and severe cranial ultrasound pathologies compared to PLV.
• Further research is needed to confirm neurodevelopmental benefits and optimize VTV strategies.