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Synchronized intermittent mandatory ventilation with volume guarantee during neonatal transport reduced excessive tidal volumes and peak inflating pressures. However, it also led to a greater contribution of spontaneous breaths to minute ventilation compared to ventilation without volume guarantee.

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Area of Science:

  • Neonatal critical care
  • Respiratory support
  • Transport medicine

Background:

  • Neonatal transport requires mechanical ventilation for critically ill infants.
  • Synchronized intermittent mandatory ventilation (SIMV) is commonly used.
  • Volume guarantee (VG) is a feature that aims to ensure consistent tidal volumes.

Purpose of the Study:

  • To compare ventilator settings and outcomes in infants receiving SIMV with VG versus SIMV without VG during emergency neonatal transport.
  • To evaluate the impact of VG on tidal volumes, inflating pressures, and ventilation distribution.

Main Methods:

  • Retrospective observational study of 77 infants undergoing emergency neonatal transfer.
  • Infants received SIMV with or without VG using a specific neonatal ventilator.
  • Detailed ventilator data were collected and analyzed using Python.

Main Results:

  • SIMV with VG resulted in lower and less variable expiratory tidal volumes (4.8 vs 6.0 mL/kg) and lower peak inflating pressures (15.5 vs 19.5 cm H2O) compared to SIMV without VG.
  • The proportion of minute ventilation from ventilator inflations was lower with VG (66% vs 83%).
  • Fewer infants in the VG group received tidal volumes >6 mL/kg or >8 mL/kg.

Conclusions:

  • Volume guarantee during neonatal transport effectively reduces excessive tidal volumes and peak inflating pressures.
  • VG ventilation is associated with a higher contribution of spontaneous breaths to minute ventilation.
  • These findings suggest a potential benefit of VG in optimizing ventilation during neonatal transport.