Volume-targeted ventilation: one size does not fit all. Evidence-based recommendations for successful use

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Pediatric Critical Care

Background:

• Level 1 evidence supports volume-targeted ventilation (VTV) for preterm infants.
• Traditional pressure-controlled ventilation is still widely used, despite VTV's benefits.
• Barriers to VTV adoption include equipment limitations and a 'one-size-fits-all' approach.

Purpose of the Study:

• To enhance clinician understanding of VTV mechanisms.
• To provide evidence-based tidal volume (V_T) targets for VTV.
• To promote the individualized application of VTV in clinical practice.

Main Methods:

• Review of existing literature on VTV and respiratory support for preterm infants.
• Analysis of lung pathophysiology relevant to VTV.
• Synthesis of data on optimal V_T targets and ventilator settings.

Main Results:

• VTV requires individualized settings based on infant-specific factors.
• Understanding lung mechanics is crucial for successful VTV implementation.
• Evidence supports specific V_T ranges for improving outcomes.

Conclusions:

• Individualized VTV, considering lung pathophysiology and specific V_T targets, is key.
• Overcoming barriers to VTV adoption can improve clinical outcomes in vulnerable infants.
• Clinician education on VTV principles and application is essential for widespread uptake.