Volume-guarantee vs. pressure-limited ventilation in evolving bronchopulmonary dysplasia

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Extremely premature infants (<28 weeks) face high risks of bronchopulmonary dysplasia (BPD).
• Ventilator support is often necessary, with evolving BPD requiring specific management strategies.
• Current practices include pressure-limited ventilation (PLV) and volume-guarantee ventilation (VGV), a form of volume-targeted ventilation (VTV).

Purpose of the Study:

• To test the hypothesis that VGV use in evolving BPD is associated with improved clinical and pulmonary outcomes compared to PLV.
• To evaluate the impact of different ventilation strategies on BPD development and associated outcomes in extremely premature infants.

Main Methods:

• Retrospective cohort review of 471 extremely premature infants (<28 weeks) from January 2015 to December 2020.
• Analysis of ventilator data (PLV vs. VGV) at Day of Life (DOL) 14, 21, and 28.
• Assessment of ventilator 'dose' and its association with BPD, death, and length of stay (LOS).

Main Results:

• PLV at DOL 21 and 28 was linked to a significantly higher risk of BPD and the composite outcome of BPD or death before 36 weeks compared to VGV.
• Increasing doses of both VGV and PLV were associated with higher odds of BPD and the composite outcome.
• Each additional time point of VGV or PLV exposure increased predicted LOS by 15.3 and 28.8 days, respectively (p<0.001).

Conclusions:

• VGV use at DOL 21 and 28 is associated with a decreased risk of BPD compared to PLV in extremely premature infants.
• Both ventilation modalities, when used for longer durations, are associated with increased length of stay.
• Prospective trials are warranted to confirm the optimal ventilatory strategy for infants with evolving BPD.