Utilization of Volume-Targeted Ventilation in Neonatal Intensive Care Units in the United Arab Emirates: A Survey of...

Volume-targeted ventilation (VTV) is an evidence-based, lung-protective strategy demonstrated to reduce the incidence of bronchopulmonary dysplasia (BPD) and severe neurologic injury in premature infants. While variations in VTV adoption are well-documented in North America and Europe, data characterizing its utilization across the broader Middle East remains limited.

To evaluate the utilization rates of VTV, the selection of tidal volume (VT) targets across various clinical scenarios, and the perceived barriers to VTV implementation among practicing neonatologists in the United Arab Emirates (UAE).

A cross-sectional survey was distributed to practicing neonatologists across multiple regions in the UAE. The survey assessed clinician and unit characteristics, core ventilation practices, scenario-based VT targeting, and barriers to VTV implementation.

A total of 94 responses were analyzed. VTV was the most commonly reported invasive mode, with 78 (84.8%) of respondents classified as regular VTV users. VTV was predominantly utilized across both the acute and weaning phases of ventilation, with 60 (64.5%) respondents reporting its use. The reported median VT limits ranged from 4.0 to 6.0 mL/kg. Scenario-based responses revealed a median initial VT target of 5.0 mL/kg for a 500-g, 24-week infant with respiratory distress syndrome (RDS), 5.0 mL/kg for a term infant with meconium aspiration syndrome (MAS), and 4.0 mL/kg for an infant with congenital diaphragmatic hernia (CDH). High-frequency oscillatory ventilation (HFOV) was widely used (78, 97.5%); however, the use of volume guarantee (VG) during HFOV remained uncommon (28, 36.4%). Regular VTV use was significantly associated with ≥10 years of experience (P = 0.011) and practice in an academic/training level III NICU (P = 0.021). Unlike North American cohorts, the primary reported barrier to VTV adoption in the UAE was equipment unavailability rather than a lack of clinical understanding.

The UAE demonstrates a high rate of VTV adoption, aligning with the most progressive international benchmarks. However, scenario-specific VT targeting reveals a tendency to default to standard volumes regardless of the underlying lung pathophysiology. Continued efforts should focus on optimizing equipment availability and providing targeted education on individualizing VT settings to further elevate neonatal respiratory care.