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Early volume targeted ventilation in preterm infants born at 22-25 weeks of gestational age

Linda Wallström1, Amanda Sjöberg1, Richard Sindelar1

  • 1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Pediatric Pulmonology
|February 21, 2021
PubMed

Insights

Volume targeted ventilation (VTV) in extremely preterm infants reduced hypocapnia, a condition linked to brain injury and lung disease. This study found VTV safe and effective in this vulnerable population.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Critical Care

Background:

  • Early hypocapnia in preterm infants is a risk factor for intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD).
  • Volume targeted ventilation (VTV) is known to reduce hypocapnia in preterm infants, but its use in extremely preterm infants (<26 weeks gestational age) is less understood.

Purpose of the Study:

  • To compare the short- and long-term effects of early VTV versus pressure limited ventilation (PLV) in extremely preterm infants.
  • To investigate the incidence of hypocapnia, duration of ventilatory support, and rates of IVH and BPD.

Main Methods:

  • A retrospective observational study included 104 infants born at 22-25 weeks gestational age.
  • Infants received either VTV (n=44) or PLV (n=60) on their first day of life.
  • Ventilatory data, blood gases, and clinical outcomes were collected and analyzed.

Main Results:

  • VTV resulted in lower peak inflation pressures and a significantly lower incidence of hypocapnia (32% vs. 62%) during the first day of life compared to PLV.
  • Infants in the VTV group were extubated more frequently at 24 hours (30% vs. 13%).
  • No significant differences were observed in the incidence of severe IVH (Grade ≥3), BPD, or duration of mechanical ventilation between the groups.

Conclusions:

  • Volume targeted ventilation (VTV) is safe for extremely preterm infants (<26 weeks GA).
  • Early VTV use in this population leads to a reduced incidence of hypocapnia compared to PLV.
  • VTV did not result in different rates of IVH, BPD, or duration of ventilation compared to PLV.
Abstract

Keywords:
extremely prematurehypocapniamechanical ventilationoutcomes

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