Comparison of Assist/Control Ventilation with and without Volume Guarantee in Term or Near-Term Infants

 

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Abstract

Objectives This study aimed to compare the effects of volume guarantee (VG) combined with assist/control (AC) ventilation to AC alone on hypocarbia episodes and extubation success in infants born at or near term.

Methods In this prospective cohort study, infants >34 weeks of gestation at birth, who were born in our hospital supported by synchronized, time-cycled, pressure limited, assist/control ventilation (AC) or assist-controlled VG mechanical ventilation (AC + VG) were included. After admission, infants received either AC or VG + AC using by Leoni Plus ventilator. The ventilation mode was left to the clinician. In the AC group, peak airway pressure was set clinically. In the VG + AC group, desired tidal volume was set at 5 mL/kg, with the ventilator adjusting peak inspiratory pressure to deliver this volume. The study was completed once the patient extubated.

Results There were 35 patients in each group. Incidence of hypocarbia was lower in the VG + AC compared with AC (%17.1 and 22.8%, respectively) but statistically not significant. Out-of-range partial pressure of carbon dioxide (PCO₂) levels were lower in the VG + AC group and it reached borderline statistical significance (p = 0.06). The median extubation time was 70 (42–110) hours in the VG + AC group, 89.5 (48.5–115.5) hours in the AC group, and it did not differ between groups (p = 0.47).

Conclusion We found combining AC and VG ventilation compared with AC ventilation alone yielded similar hypocarbia episodes and extubation time for infants of >34 gestational weeks with borderline significance lower out-of-range PCO₂ incidence.

Key Points

• Underlying lung pathology requiring mechanical ventilation support in term infant is heterogeneous.

• VG ventilation compared with conventional modes yielded similar hypocarbia episodes in term infants.

• Combining VG ventilation lead to borderline significance lower out-of-range PCO₂ incidence.

Authors' Contributions

N.O. had primary responsibility for protocol development and analytic framework of the study, outcome assessment, and manuscript preparation. H.B. and F.N.S. participated in the development of the protocol and analytic framework of the study, had primary responsibility for review of the files, patient screening, enrollment, and data entry, and prepared the manuscript with N.O. M.B., E.A.D., and S.S.O. contributed to preparation and revision of the manuscript.

Publication History

Received: 31 January 2022

Accepted: 11 May 2022

Accepted Manuscript online:
25 May 2022

Article published online:
05 July 2022

© 2022. Thieme. All rights reserved.

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