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

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Milenka Cuevas Guaman1, Joseph Hagan1, Dajana Sabic1

  • 1Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.

Frontiers in Pediatrics
|January 9, 2023
PubMed

Insights

Volume-guarantee ventilation (VGV) use in extremely premature infants with evolving bronchopulmonary dysplasia (BPD) was associated with a decreased risk of BPD compared to pressure-limited ventilation (PLV). Further trials are needed to confirm these findings.

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.
Abstract

Keywords:
BPD (bronchopulmonary dysplasia)prematurepressure-limited ventilationventilaionvolume-guaranteed ventilation

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