Pressure-Regulated Volume Control Ventilation Versus Pressure Control Ventilation on Oxygenation and Lung Dynamics of...

Introduction Acute respiratory failure in neonates presents as a critical challenge in neonatal intensive care units (NICUs), where mechanical ventilation plays a key role in management. Pressure control ventilation (PCV) is a conventional mode commonly used for ventilatory support. With technological advancements, newer modes such as pressure-regulated volume control (PRVC) have emerged, offering some potential benefits. However, studies comparing the effectiveness of PRVC to PCV in improving oxygenation and lung dynamics in neonates remain limited. This study aims to compare the effects of the PRVC mode to the PCV mode of ventilation in neonates with acute respiratory failure. Objective The objective of this study is to evaluate and compare the effectiveness of PRVC and PCV ventilation modes on oxygenation and lung dynamics in neonates with acute respiratory failure. We hypothesized that the PRVC mode would result in better oxygenation and lung dynamics compared to PCV in neonates with acute respiratory failure. Method This quasi-experimental study was conducted at the NICU of Bangladesh Shishu Hospital and Institute (BSH&I) from April 2023 to March 2025. A total of 60 neonates meeting the inclusion and exclusion criteria were enrolled and nonrandomly allocated into two groups: PRVC (n=30) and PCV (n=30). Oxygenation parameters (partial pressure of oxygen {PaO₂}, peripheral oxygen saturation {SpO₂}, fraction of inspired oxygen {FiO₂}, and PaO₂/FiO₂ {P/F} ratio), lung dynamics (compliance, driving pressure, and respiratory rate {RR}), arterial blood gas (ABG) values (pH, partial pressure of carbon dioxide {PaCO₂}, and bicarbonate {HCO₃}), and ventilator parameters (tidal volume (V_T), peak inspiratory pressure (PIP), positive end expiratory pressure {PEEP}, and mean airway pressure {MAP}) were assessed and compared at initiation and one hour and 24 hours post-ventilation between the two groups. Statistical analysis determined significant differences between groups. Results Baseline characteristics were similar between the two groups. At one hour, SpO₂ (p=0.002), PaO₂ (p=0.002), and the P/F ratio (p=0.001) were significantly higher in the PRVC group; this trend also persisted at 24 hours (p<0.05). FiO₂ requirements were lower in PRVC at one hour (p=0.036) and 24 hours (p=0.024). PRVC also resulted in a significantly lower respiratory rate at 24 hours (p=0.033). Tidal volume remained higher (p<0.05), while peak inspiratory pressure and mean airway pressure were consistently lower in the PRVC group (p<0.001). No significant differences were observed in lung compliance, driving pressure, PEEP, and ABG parameters within 24 hours. Conclusion This study concluded that the PRVC mode provides better oxygenation than the PCV mode with a lower mean airway pressure, while both modes have similar effects on lung dynamics in neonates with acute respiratory failure.